嵌顿性腹股沟疝急诊手术术后复发影响因素的Cox 回归分析

Cox regression analysis on the factors associated with relapse of incarcerated inguinal hernia after emergency surgery

目的:构建影响嵌顿性腹股沟疝急诊术后复发的临床预测模型,探明影响嵌顿性腹股沟疝急诊术后复发的因素。方法:连续性收集芜湖市第一人民医院普外科2016年7月31日~2018年9月30日急诊入院的嵌顿性腹股沟疝并行手术治疗者为研究对象,出院后随访12~20个月,分析嵌顿性腹股沟疝急诊术后复发的影响因素。结果:单因素分析显示,年龄、BMI、吸烟占比、慢阻肺占比、植入补片占比、手术方式、手术持续时间、住院时间、术中腹膜破损占比、术后尿潴留占比、术后盆腔感染占比及血肿/浆液肿占比与嵌顿性腹股沟疝术后复发有关,差异均有统计学意义(P<0.05)。多因素Cox回归分析显示,BMI增大(RR=2.685,95%CI:1.533~4.701)、手术持续时间长(RR=1.067,95%CI:1.031~1.104)、术中出现腹膜破损并发症(RR=3.777,95%CI:1.201~11.882)和术后出现盆腔感染并发症(RR=7.433,95%CI:2.438~22.665)是嵌顿性腹股沟疝术后复发的危险因素。结论:肥胖、手术时间长、术中腹膜破损及术后盆腔感染者,嵌顿性腹股沟疝急诊术后复发率高,临床医生应高度重视。

Objective:To establish a clinical model for predicting the factors affecting recurrence of incarcerated inguinal hernia following emergency operation.Methods:Cases of incarcerated inguinal hernia undergone emergency surgery in the Department of General Surgery of Wuhu No.1 People′s Hospital were included from July 31,2016 to September 30,2018.All patients received follow-up for 12 to 20 months.Cox regression model was used to analyze the factors involved in relapse after operation.Results:Single factor analysis showed that the factors causing relapsed hernia after surgery were associated with the age,BMI,proportion of smokers,chronic obstructive pulmonary disease and implanted mesh patch,operation modality and surgical duration,days of hospital stay,ratio of intraoperative peritoneal breakage,postoperative urine retention and pelvic infection as well as ratio of incidence of hematoma/grout swelling.The difference was significant(P<0.05).Multivariate Cox regression analysis showed that increased BMI(RR=2.685,95%CI:1.533-4.701),operation duration(RR=1.067,95%CI:1.031-1.104),complicated intraoperative peritoneal breakage(RR=3.777,95%CI:1.201-11.882)and postoperative complications of pelvic infection(RR=7.433,95%CI:2.438-22.665)were risks for recurrence of incarcerated inguinal hernia.Conclusion:Obesity,longer operative time,incidence of intraoperative peritoneal damage and postoperative pelvic infection can result in higher relapse in patients with incarcerated inguinal hernia following emergency surgery,which should be albert by the clinicians.