经腹股沟切口路径放置补片疝修补术治疗急诊股疝的临床疗效

Clinical efficacy of mesh repair via inguinal approach in acute femoral hernia

目的：探讨经腹股沟切口路径放置补片疝修补术治疗急诊股疝的临床疗效。方法：采用回顾性队列研究方法。收集2007年1月至2016年12月复旦大学附属华东医院收治的48例急诊股疝患者的临床资料。48例患者中， 29例行疝修补术中采用聚丙烯补片修补，设为研究组；19例行疝修补术中采用缝合修补，设为对照组。患者均采用经腹股沟切口路径行疝修补术。观察指标：（1）手术及术后情况。（2）随访和生存情况。采用门诊和电话方式进行术后随访，分别在术后1、3个月及1年各随访1次，终点为术后1年。随访内容包括并发症、疝复发和生存情况。随访时间截至2017年12月。正态分布的计量资料采用±s表示，组间比较采用t检验；计数资料比较采用x2检验或Fisher确切概率法。结果：（1）手术及术后情况：两组患者均成功行嵌顿或绞窄急诊股疝修补术。研究组和对照组患者中分别有3例和4例行小肠切除术，两组比较，差异无统计学意义（x2=1.50，P〉0.05）。 研究组和对照组患者手术时间分别为（82±16）min和（96±13）min，两组比较，差异有统计学意义（t=-2.94，P〈0.05）。研究组和对照组患者术中均未发生股血管损伤。研究组和对照组患者术后引流管拔除时间分别为（4.5±1.6）d和（3.9±1.3）d，两组比较，差异无统计学意义（t=1.36，P〉0.05）。研究组和对照组患者术后住院时间分别为（9±4）d和（10± 4）d，两组比较，差异无统计学意义（t=-0.33，P〉0.05）。（2） 随访和生存情况：48例患者均获得术后随访1年。研究组患者未见补片感染。研究组和对照组患者中分别有4例和2例术后切口感染，两组比较，差异无统计学意义（x2=0.11，P〉0.05），均经切口敞开引流后痊愈。研究组和对照组患者中各有2例术后慢性疼痛，两组比较，差异无统计学意义（x2=0.20，P〉0.05），均为轻度间歇性，无需特殊处理。两组患者术后均未出现血清肿。研究组患者中未见疝复发，对照组5例疝复发，两组比较，差异有统计学意义（x2=8.52，P〈0.05）。研究组和对照组患者中分别有2例和1例死亡，两组生存情况比较，差异无统计学意义（P〉0.05）。结论：经腹股沟切口路径放置聚丙烯补片疝修补术治疗急诊股疝安全可行，与缝合修补手术方式比较，缩短手术时间，降低疝复发率，且未发现术后补片感染，未增加术后并发症的发生。

Objective：To investigate the clinical efficacy of mesh repair via inguinal approach in acute femoral hernia. Methods：The retrospective cohort study was conducted. The clinical data of 48 patients with acute femoral hernia who were admitted to Huadong Hospital Affiliated to Fudan University between January 2007 and December 2016 were collected. Of 48 patients, 29 undergoing hernia repair with polypropylene mesh and 19 undergoing hernia repair with suture were allocated into the study group and control group respectively. All the patients underwent hernia repair via inguinal approach. Observation indicators： （1） surgical and postoperative situations; （2） follow-up and survival situations. follow-up was performed by outpatient examination and telephone interview to detect complications, hernia recurrence, survival situations at 1, 3month and 1 year postoperatively for 1 year up to December 2017. Measurement data with normal distribution were represent as ±s and comparison between groups was done by the t test. Comparison of count data was analyzed using the chi-square test or Fisher exact probability. Results：（1） Surgical and postoperative situations： patients in the 2 groups underwent successful incarcerated or strangulated acute femoral hernia repair. There were 3 and 4 patients receiving small bowel resection in the study group and control group respectively, with no statistically significant difference between groups （x2=1.50, P〉0.05）. The operation time was respectively （82±16）minutes and （96±13）minutes in the study group and control group, with statistically significant difference between groups （t=-2.94, P〈0.05）. There was no femoral vascular injury in the 2 groups. The time of drainagetube removal and duration of postoperative hospital stay were respectively （4.5±1.6）days and （9±4）days in the study group and （3.9± 1.3）days and （10±4）days in the control group, with no statistically significant difference between groups （t =1.36, -0.33, P〉0.05）. （2） follow-up and survival situations： all the 48 patients were followed up for one year. No mesh infection was found in the study group. Incisional infection was detected in 4 and 2 patients of the study group and control group respectively, with no statistically significant difference between groups （x2=0.11, P〉0.05）. Patients with incisional infection were cured after incision open drainage. Two and 2 patients had postoperative chronic pain in the study group and control group respectively, with no statistically significant difference between groups （x2=0.20, P〉0.05）. The 4 patients had mild intermittent pain, without special treatment. There were no seroma occurred in the 2 groups. Hernia recurrence was occurred in 0 and 5 patients of the study group and control group respectively, with statistically significant difference between groups （x2=8.52, P〈0.05）. There were 2 and 1 patient dead in the study group and control group respectively, with no statistically significant difference between groups （P〉0.05）. Conclusions：Hernia repair with Polypropylene mesh via inguinal approach in acute femoral hernia is safe and feasible. Compared to suture repair, it can not only shorten operation time and reduce hernia recurrence, but also had no mesh infection and cannot increase postoperative complications.