腹腔镜腹股沟疝修补术后血清肿的成因分析及防治体会

Prevention and treatment of seroma after laparoscopic inguinal hernia repair

目的探讨腹腔镜腹股沟疝修补术后血清肿发生的原因及防治措施。方法回顾性分析2014年1月至2018年4月湛江中心人民医院收治并行腹腔镜腹股沟疝修补术的538例患者临床资料,观察术后血清肿的发生情况,分析总结血清肿的发生原因及防治措施。结果 538例患者术后出现血清肿39例,血清肿的发生率为7.2%,其中Ⅰ/Ⅱ型33例(6.1%),给予观察及中药芒硝外敷处理后痊愈;Ⅲ型5例(1.0%),给予中药芒硝外敷、细针穿刺抽吸等处理后症状好转;Ⅳ型1例(0.2%),经反复抽吸症状未明显改善并伴有补片排斥反应,遂行二次手术取出补片及彻底清除血清肿后痊愈。Logistic多因素回归分析显示术前合并症、疝严重程度、手术方式和疝囊离断是术后血清肿发生的影响因素(χ~2=4.165、11.242、3.857、4.802,P=0.031、0.001、0.045、0.029)。结论腹腔镜腹股沟疝修补术后血清肿发生与多种因素相关,可通过围手术期多种措施来防治血清肿的发生。

Objective：To investigate the causes, prevention and treatment of seroma after laparoscopic inguinal hernia repair. Methods：A retrospective analysis was conducted in five hundred and thirty-eight cases undergoing laparoscopic inguinal hernia repair surgery in the Central People＆#39;s Hospital of Zhanjiang City from January 2014 to April 2018. Methods：Thirty-nine of the 538 patients had seroma after operation, the incidence of seroma was 7.2%, including 33 cases （6.1%） of type /Ⅱ treated with external application of mirabilite, 5 cases （1.0%） of type Ⅲ and the symptoms were improved after external application of mirabilite, fine needle aspiration and other treatments, 1 case （0.2%） of type Ⅳ and the symptoms were not significantly improved after repeated aspiration and accompanied by patch rejection. The second operation took out the patch and completely cleared the serum. Preoperative complications, severity of hernia, surgical methods and hernia sac separation were the influencing factors of postoperative seroma （χ2=4.165,11.242, 3.857, 4.802, P=0.031, 0.001, 0.045, 0.029）. Conclusion：The occurrence of seroma after laparoscopic inguinal hernia repair is related to a variety of factors, and various measurements can be taken during the perioperative period to prevent and treat it.