股疝修补术的临床疗效分析

Clinical efficacy analysis of femoral hernia repair

目的探讨股疝修补术的临床疗效。方法采用回顾性描述性研究方法。收集2012年1月至2019年1月新疆维吾尔自治区人民医院收治的102例股疝患者的临床资料;男13例,女89例;年龄为(65±9)岁,年龄范围为31~91岁。患者根据《成人腹股沟疝诊断和治疗指南(2018年版)》标准施行急诊手术或择期手术。手术方式为腹腔镜经腹腹膜前疝修补术(TAPP)、McVay修补术或开放腹膜前间隙补片修补术。观察指标:(1)术中及术后情况。(2)随访情况。采用门诊或电话方式进行随访,了解患者并发症和疝复发情况。随访时间截至2019年2月。正态分布的计量资料以±s表示。计数资料以绝对数表示。结果(1)术中及术后情况:102例患者均为单侧股疝,其中左侧疝57例,右侧疝45例;79例发生嵌顿或绞窄,23例未发生嵌顿或绞窄。79例嵌顿或绞窄股疝患者行急诊手术,其中35例行开放McVay修补术(5例为腹腔镜手术中转),44例行腹腔镜TAPP。23例未发生嵌顿或绞窄股疝患者均行择期手术,其中3例行开放腹膜前间隙补片修补术,20例行腹腔镜TAPP。102例患者中,87例术中使用补片。102例患者手术时间为(62±3)min;102例患者术中均留置引流管,术后引流管拔除时间为(2.2±0.3)d;术后住院时间为(3.5±1.3)d。(2)随访情况:102例患者均获得术后随访,随访时间为(7±3)个月,随访时间范围为1~12个月。79例行急诊手术患者中,随访期间肺部感染、深静脉血栓、伤口感染、肠梗阻、血清肿、肠瘘、患侧疝复发分别为5、4、3、3、1、1、1例,死亡3例。1例术后肠瘘患者行二次肠造口术,术后3个月行肠还纳术,其余并发症患者均经对症支持治疗后好转。23例行择期手术患者中,随访期间血清肿、肠瘘、患侧疝复发各1例,均经对症支持治疗后好转。结论早期、准确诊断,且选择适合的手术方式及时施行手术可有效治疗股疝。

Objective To investigate the clinical efficacy of femoral hernia repair.Methods The retrospective and descriptive study was conducted.The clinical data of 102 patients with femoral hernia who were admitted to People′s Hospital of Xinjiang Uygur Autonomous Region from January 2012 to January 2019 were collected.There were 13 males and 89 females,aged(65±9)years,with a range from 31 to 91 years.Patients underwent emergency or selective surgery according to Guideline for diagnosis and treatment of adult inguinal hernia(2018 edition),including laparoscopic transabdominal preperitoneal hernia repair(TAPP),McVay repair or open preperitoneal mesh hernioplasty.Observation indicators:(1)intraoperative and postoperative situations;(2)follow-up.Follow-up using outpatient examination or telephone interview was conducted to detect complications and hernia recurrence up to February 2019.Measurement data with normal distribution were represented as Mean±SD,and count data were represented as absolute numbers.Results(1)Intraoperative and postoperative situations:102 patients had unilateral femoral hernia,including 57 of left hernia and 45 of right hernia.There were 79 patients with incanceration or strangulation,and 23 without incanceration or strangulation.The 79 patients with incancerated or strangulated hernia underwent emergency surgery,including 35 undergoing open McVay repair(5 had conversion from laparoscopic surgery)and 44 undergoing laparoscopic TAPP.The 23 patients without incanceration or strangulation underwent selective surgery,including 3 undergoing open preperitoneal mesh hernioplasty and 20 undergoing laparoscopic TAPP.Meshes were used on 87 of the 102 patients.The operation time,time to postoperative drainage tube removal,and duration of postoperative hospital stay were(62±3)minutes,(2.2±0.3)days,and(3.5±1.3)days,respectively.(2)Follow-up:102 patients were followed up for(7±3)months,with a range from 1 to 12 months.During the follow-up,pulmonary infection,deep venous thrombosis,incisional infection,intestinal obstruction,seroma,intestinal fistula,and affected hernia recurrence were observed in 5,4,3,3,1,1,and 1 of the 79 patients undergoing emergency surgery,respectively.There were 3 patients dead.One patient with intestinal obstruction underwent secondary enterostomy and then closure at postoperative 3 months.The other patients with complications were improved after symptomatic and supportive treatment.During the follow-up,seroma,intestinal fistula,and affected hernia recurrence were observed in 1,1,and 1 of the 23 patients with selective surgery.The above patients with complications were improved after symptomatic and supportive treatment.Conclusion Early and correct diagnosis,selection of appropriate surgical methods,and immediate surgery can effectively treat femoral hernia.