腹股沟疝修补术后腹膜前间隙出血危险因素分析及急诊处理

Risk factors and emergency treatment of preperitoneal space hemorrhage after inguinal hernia repair

目的探讨腹股沟疝患者行腹膜前修补术后腹膜前间隙出血的危险因素及急诊处理。方法选取2012年1月至2016年12月杭州市第一人民医院疝和腹壁外科收治的2 096例腹股沟疝患者行腹膜前修补手术,经腹部CT明确术后腹膜前间隙出血。将38例明确为腹膜前间隙出血的患者纳入病例组,76例未出血腹股沟疝腹膜前修补手术患者纳入对照组。对两组患者的一般资料进行比较,采用Logistic多元回归分析腹股沟疝腹膜前修补术后腹膜前间隙出血的危险因素。结果病例组患者中37例经非手术治疗后痊愈,成功率为97.37%(37/38)。两组腹股沟疝腹膜前修补手术患者在住院时间[(9.1±3.3)d vs.(5.8±2.5)d,t=3.282,P=0.037]、术前抗凝(26/38 vs.25/76,χ2=4.271,P=0.002)、复发疝(22/38 vs.25/76,χ2=3.450,P=0.019)、手术时间延长(24/38 vs.17/76,χ2=4.628,P=0.004)、学习曲线早期(30/38 vs.15/76,χ2=0.655,P=0.013)、血红蛋白下降幅度[(36±13)g/L vs.(22±7)g/L,t=24.21,P<0.001]及血压下降幅度[(34±9)mm Hg vs.(17±8)mm Hg,t=0.219,P=0.006]方面比较,差异均有统计学意义。将上述有统计学差异的指标纳入Logistic多元回归分析。结果显示,术前抗凝[OR=4.759,95%CI(1.286,17.606),P=0.019]、复发疝[OR=2.203,95%CI(1.051,6.818),P=0.025]、手术时间延长[OR=3.219,95%CI(1.060,4.792),P=0.021]、学习曲线早期[OR=13.814,95%CI(3.731,51.146),P<0.001]、血红蛋白下降幅度[OR=26.255,95%CI(4.688,56.343),P=0.020]及血压下降幅度[OR=34.091,95%CI(11.494,82.442),P<0.001]为腹股沟疝腹膜前修补术后腹膜前间隙出血的危险因素。结论腹股沟疝修补术后腹膜前间隙出血采用非手术治疗是安全有效的。术前抗凝、复发疝、手术时间延长、学习曲线早期、血红蛋白下降幅度及血压下降幅度是腹股沟疝修补术后腹膜前间隙出血的危险因素。

Objective To investigate risk factors and emergency treatment of inguinal hernia patients with preperitoneal space hemorrhage after preperitoneal repair surgery. Methods A total of 2 096 patients with inguinal hernia in Department of Hernia and Abdominal Wall Surgery of Hangzhou First People＇s Hospital from January 2012 to December 2016 were treated with preperitoneal repair surgery and used abdominal CT to diagnose their preperitoneal space hemorrhage. Thirty-eight patients with preperitoneal space hemorrhage were included in the case group, and 76 patients without preperitoneal space hemorrhage were included in the control group. The general data of two groups were compared, and the risk factors for preperitoneal space hemorrhage after preperitoneal repair of inguinal hernia were analyzed by Logistic multivariate regression analysis. Results Thirty-seven cases in the case group were cured by non-surgical treatment, and the success rate was 97.37%（37/38）. The length of stay [（9.1 ＋ 3.3） d vs.（5.8 ＋2.5） d, t = 3.282, P = 0.037], preoperative anticoagulation（26/38 vs. 25/76, χ2= 4.271, P =0.002）, recurrent hernia（22/38 vs. 25/76, χ2= 3.450, P = 0.019）, prolonged operation time（24/38 vs. 17/76, χ2= 4.62 8, P = 0.004）, the early learning curve（30/38 vs. 15/76, χ2= 0.655, P =0.013）, decreased hemoglobin [（36 ＋ 13） g/L vs.（22 ＋ 7） g/L, t = 24.21, P 0.001] and declined blood pressure [（34 ＋ 9） mm Hg vs.（17 ＋ 8） mm Hg, t = 0.219, P = 0.006] of these two groups were statistically different. These statistically different indicators were included in the Logistic multivariate regression analysis. The results showed that preoperative anticoagulation [OR = 4.759,95%CI（1.286, 17.606）, P = 0.019], recurrent hernia [OR = 2.203, 95% CI（1.051, 6.818）, P =0.025], prolonged operation time [OR = 3.219, 95%CI（1.060, 4.792）, P = 0.021], the early learning curve [OR = 13.814, 95%CI（3.731, 51.146）, P 〈0.001], decreased hemoglobin [OR = 26.255, 95%CI（4.688, 56.343）, P = 0.020] and declined blood pressure [OR = 34.091, 95%CI（11.494, 82.442）, P〈 0.001] were the risk factors of preperitoneal space hemorrhage after preperitoneal repair of inguinal hernia. Conclusions Non-surgical treatment is safe and effective in preperitoneal space hemorrhage after inguinal hernia repair surgery. Preoperative anticoagulation, recurrent hernia,prolonged operation time, the early learning curve, decreased hemoglobin and declined blood pressure were the risk factors of preperitoneal space hemorrhage after inguinal hernia repair surgery.