妊娠期合并腹股沟疝患者的治疗策略及预后分析

Analysis on therapeutic strategies and prognosis of patients with inguinal hernia during pregnancy

目的分析并总结妊娠期合并腹股沟疝患者的临床特点、治疗策略及预后。方法回顾性分析2006年11月-2015年10月中国医科大学附属盛京医院收治的29例妊娠期合并腹股沟疝患者的临床资料,并通过电话和门诊复诊的方式进行随访,随访时间截至2016年8月。对数据进行统计学分析。结果在29例妊娠期合并腹股沟疝患者中,以患单侧腹股沟疝为主占93.10%(27/29),患腹股沟斜疝居多占86.21%(25/29)。Ⅰ型疝21例,Ⅱ型疝8例,无Ⅲ型及Ⅳ型疝。3例疝的出现时间在妊娠早期(≤12周),5例在妊娠中期(13~27周),妊娠晚期(≥28周)有21例。经阴道分娩的患者1例,采用剖宫产的患者为28例。1例因腹股沟疝发生嵌顿而行急诊手术,术中联合行疝囊高位结扎术,未留置补片,剩余28例均未在住院期间联合处理腹股沟疝。27例患者获得随访(93.10%),随访时间为11~118个月,平均为(65.66±37.47)个月。在获得随访的27例中,1例已与剖宫产同时行疝修补术,其余26例未联合治疗腹股沟疝的患者在随访中共有10例择期行无张力疝修补术,另16例原有腹股沟区包块均在产后1~4个月内自然消失,随访期间未见疝复发。单因素分析结果显示,腹股沟疝出现时的孕周及腹股沟疝的分型是影响产后腹股沟疝预后的因素,差异有统计学意义(χ2=6.659、9.329,均P<0.05)。结论妊娠期合并腹股沟疝最常于妊娠晚期发生,类型以Ⅰ型为主,以斜疝为主,左侧比右侧更容易出现。合并腹股沟疝并非经阴道分娩禁忌证。治疗策略原则为"个体化"和"密切观察"。除疝嵌顿或疝环缺损较大以外,分娩过程中建议暂不处理腹股沟疝,等到产后临床症状加重时再行治疗。

Objective To analyze and summarize the clinical characteristics,therapeutic strategies,and prognosis of patients with inguinal hernia during pregnancy. Methods The clinical data of 29 cases with inguinal hernia during pregnancy treated in the hospital from November 2006 to October 2015 was analyzed retrospectively. All the patients were followed up through telephone or out-patient examination till October 2016. The data was statistically analyzed. Results Most of the patients with inguinal hernia during pregnancy were unilateral inguinal hernia with the proportion of 93. 10%（ 27/29）,and the predominant type was oblique inguinal hernia with the proportion of 86. 21%（ 25/29）. There were 21 cases of type Ⅰ,8 cases of type Ⅱ,and no case of type Ⅲ and Ⅳ. Inguinal hernia occurred during the first trimester of pregnancy（ 1-12 gestational weeks） in 3 cases,the second trimester of pregnancy（ 13-27 gestational weeks） in 5 cases,the third trimester of pregnancy（ ≥28 gestational weeks） in 21 cases. One case adopted vaginal delivery,and 28 cases adopted cesarean section.One case underwent emergency surgery combined with high ligation of hernial sac due to inguinal incarcerated hernia without mesh,the other28 cases did not received inguinal hernia surgery during hospitalization. Twenty-seven patients were followed up,the rate was 93. 10%. The time of follow-up ranged 11-118 months,and the average time was（ 65. 66± 37. 47） months. According to follow-up results of 27 cases,one patient underwent hernia repair surgery during cesarean section,among the other 26 cases not treated by hernia repair surgery,10 cases underwent tension-free hernioplasty,and the inguinal masses disappeared in the other 16 cases during 1-4 months after delivery,no recurrence was found during follow-up. Univariate analysis showed that the influencing factors of prognosis of inguinal hernia after delivery were gestational weeks and clinical types of inguinal hernia（ χ2= 6. 659,9. 329,P0. 05）. Conclusion Most of inguinal hernia during pregnancy occurs during the third trimester of pregnancy,the major type is type Ⅰ,most of them are oblique,and the predominant lesion side was left. Pregnancy combined with inguinal hernia is not the contraindication of vaginal delivery. The principles of treatment strategies are individualization and close observation. Apart from incarcerated hernia or large defect of mesh,it is not recommended to treat inguinal hernia in labor. Treatment can be taken when postpartum symptoms are more severer.