腹壁切口疝修补术后腹壁膨出相关因素研究

The risk factors of bulging after hernia repair of ventral hernia

目的探讨腹壁切口疝术后腹壁膨出(bulging)及复发的发生率及其相关危险因素。方法回顾性分析2008年1月至2017年12月,复旦大学附属华东医院行腹壁切口疝修补术治疗的774例患者临床资料,观察腹壁膨出及疝复发的发生率与临床病例因素的关系。结果术后平均住院时间(8.15±2.60)d,随访时间3~78个月。术后腹壁膨出58例(7.49%),患者体质量指数(BMI)、是否急诊手术、是否使用补片、补片放置层次、手术入路、是否关闭腹壁缺损等与腹壁切口疝修补术后腹壁膨出有关。结论影响腹壁切口疝术后腹壁膨出发生的独立危险因素为BMI、是否急诊手术、是否使用补片、补片放置的层次、手术入路、是否关闭腹壁缺损。临床应加强术前病例的筛选,减少急诊手术的同时,严格控制患者体重,选择合适的手术方式和植入修补、确实关闭腹壁缺损,并加强术后切口管理,以预防和减少腹壁切口疝术后腹壁膨出的发生。

Objective To investigate the incidence and risk factors of bulging after herniorrhaphy for ventral hernia. Methods To analysis of the relationship between incidence and clinical case factors of 774 patients who underwent herniorrhaphy for ventral hernia from January 2008 to December 2017. Results After 3 to 18 months of follow-up, the postoperative hospital stay was (8.15±2.60) days, bulging was found in 58 cases (7.49%) of 774 patients postoperatively, which was correlated with body mass index (BMI), emergency cases, mesh position, surgical approach and defect closure. Conclusion The BMI, emergency cases, mesh position, surgical approach and defect closure were independent risk factors of bulging after herniorrhaphy for ventral hernia. In order to prevent and reduce the occurrence of bulging, we should strengthen the screening of preoperative cases, reduce the emergency operation rate, strictly control the weight of patients, select appropriate surgical methods and materials, close the defect facial and strengthen the management of incision after operation.