腹股沟嵌顿斜疝发生的危险因素及不同手术方式的治疗效果

Risk factors of incarcerated indirect inguinal hernia and therapeutic effects of different surgical methods

目的分析腹股沟嵌顿斜疝发生的危险因素及不同手术方式的治疗效果。方法选择2016年1月至2019年1月,芜湖市第二人民医院收治的腹股沟斜疝患者394例,根据是否发生嵌顿将患者分为嵌顿组(41例)和非嵌顿组(353例),采用多因素Logistic回归分析腹股沟斜疝患者发生嵌顿的危险因素。根据手术方法将41例发生嵌顿的腹股沟斜疝患者分为开腹组(15例)和腹腔镜组(26例),开腹组采用开腹腹股沟疝修补术进行治疗,腹腔镜组采用腹腔镜下腹股沟疝修补术进行治疗。比较2组患者手术时间、术后住院时间、疼痛情况和并发症发生率。结果 394例腹股沟斜疝患者中41例发生嵌顿,嵌顿发生率为10.41%。经多因素Logistic回归分析,患者年龄≥65岁(OR=2.307)、有腹股沟疝史(OR=2.210)以及内环口类型为大开口型(OR=2.869)为腹股沟斜疝发生嵌顿的独立危险因素(P<0.05)。腹腔镜组手术时间和术后住院时间显著短于开腹组(P<0.05),术后疼痛视觉模拟评分评分显著小于开腹组(P<0.05)。结论腹股沟斜疝发生嵌顿的独立危险因素是患者年龄≥65岁、有腹股沟疝史以及内环口类型为大开口型。采用腹腔镜下腹股沟疝修补术治疗腹股沟嵌顿斜疝能显著缩短手术时间,患者恢复更快,住院时间更短。

Objective To analyze the risk factors of incarcerated indirect inguinal hernia and the therapeutic effects of different surgical methods.Methods 394 patients with indirect inguinal hernia admitted to the Second People's Hospital of Wuhu between January 2016 and January 2019 were selected.According to the occurrence of incarceration,the patients were divided into the incarcerated group(n=41)and the non-incarcerated group(n=353).Multivariate logistic regression was used to analyze the risk factors of incarceration in patients with indirect inguinal hernia.According to the surgical method,41 cases of incarcerated indirect inguinal hernia patients were divided into the laparotomy group(n=15)and the laparoscopic group(n=26).The laparotomy group was treated with laparotomy combined with inguinal hernia repair,while the laparoscopic group was treated with laparoscopic inguinal hernia repair.The operation time,postoperative hospital stay,pain and complication rate of the two groups were compared.Results 41 out of 394 patients with indirect inguinal hernia had incarceration,and the incidence of incarceration was 10.41%.Multivariate logistic regression analysis showed that the patient's age≥65 years old(OR=2.307),history of inguinal hernia(OR=2.210),and large opening type of internal ring(OR=2.869)were independent risk factors for incarceration of indirect inguinal hernia(P<0.05).The operative time and postoperative hospital stay in the laparoscopic group were significantly shorter than the laparotomy group(P<0.05),and the postoperative Visual analogue scale(VAS)score was significantly lower than that in the laparotomy group(P<0.05).Conclusion The independent risk factors for incarceration of indirect inguinal hernia are patients age≥65,history of inguinal hernia and large opening type of internal ring,and the use of laparoscopic inguinal hernia repair in the treatment of incarcerated inguinal hernia can significantly shorten the operation time,recovery time and hospital stay.