腹股沟疝修补术后补片感染的个体化手术治疗

Individualized treatment policy for mesh infection after inguinal hernia repair

目的总结疝修补术后补片感染的个体化手术治疗经验。方法回顾性分析北京朝阳医院疝与腹壁外科2007年1月至2018年6月期间收治的392例腹股沟疝修补术后补片感染患者的临床资料。对于开刀腹股沟疝修补术后补片感染的患者,采用原切口取出补片并清除感染组织;对于腹腔镜腹股沟疝修补术后感染的患者,仍采用腹腔镜的方法取出补片。对补片感染时间、细菌类型及疝复发等指标进行分析。结果369例为开刀腹股沟疝修补术后补片感染,23例为腹腔镜腹股沟疝修补术后补片感染。发现补片感染的时间3个月以内61例,术后3个月至1年258例,术后1年以后73例。二次术后随访6~36个月,随访期间29例发生复发疝,分别在取出补片后24-34个月。感染灶细菌培养193例阳性,其中金黄色葡萄球菌126例,大肠埃希菌18例,绿脓杆菌15例。结论根据患者补片感染的具体情况制定个体化的治疗方案是安全有效的。

Objective To evaluate treatment experience for mesh infection after inguinal hernia repair.Methods 392 cases underwent surgery for mesh infection after inguinal hernia repair in Beijing Chaoyang Hospital from Jan 2007 to Jun 2018.For mesh infection after open inguinal hernia repair,infected mesh and tissue were removed by open operation,while laparoscopic operation was adopted for mesh infection after laparoscopic inguinal hernia repair.Time of infection,type of bacteria,and hernia recurrence were evaluated.Results 369 cases suffered mesh infection after open inguinal hernia repair and 23 cases were after laparoscopic inguinal hernia repair.61 cases suffered mesh infection within 3 months,258 cases were from 3 months to 1 year and 73 cases were after one year.During follow up of 6 to 36 months after operation,29 cases suffered hernia recurrence in 24 to 34 months after removal o￡mesh.Bacterial culture were positive in 193 cases,including 126 cases of staphylococcus aureus,18 cases of escherichia coli and 15 cases of pseudomonas aeruginosa.Conclusion Individualized treatment policy based on original mesh placement is safe and effective for mesh infection after inguinal herniorrhaphy.