武警官兵腹腔镜腹股沟疝修补术后血清肿原因及防治分析

Analysis of the causes and prevention of seroma after laparoscopic inguinal hernia repair in military inpatients

目的:探讨武警官兵腹腔镜腹股沟疝修补术后血清肿发生的原因及防治措施。方法:回顾分析2014年1月至2019年10月为277例武警官兵腹股沟疝患者行腹腔镜腹股沟疝修补术的临床资料,其中经腹腔腹膜前疝修补术199例,完全腹膜外疝修补术78例,分析术后血清肿发生的影响因素。结果:277例手术均获成功,术后发生血清肿15例,发生率5.42%。单因素分析显示,术后血清肿的发生与手术时间、病程(大于5年)、疝位置(双侧疝)、补片固定方式(生物胶固定)有关。血清肿患者术后1个月、3个月腹股沟疼痛调查表评分明显增高(P<0.05)。利用logistic回归模型行多因素分析,结果显示手术时间、病程(大于5年)是术后血清肿发生的独立危险因素。结论:腹腔镜腹股沟疝修补术后血清肿的发生与病程、术中过多分离有关;术中补片可不予固定;残余疝囊的敞开,术中操作仔细,尽量减少过多的疝囊剥离,从而减少出血及对淋巴管的损伤,可达到预防血清肿的目的。

Objective:To explore the causes and preventive measures of seroma after laparoscopic inguinal hernia repair in military inpatients.Methods:The clinical data of 277 patients of inguinal hernia treated by laparoscopy from Jan.2014 to Oct.2019 were analyzed retrospectively.Among them,199 patients were treated by transperitoneal preperitoneal repair,78 cases were treated by total extraperitoneal repair.Influencing factors of seroma were analyzed.Results:Two hundred and seventy-seven operations were successful,15 cases of seroma occurred,the incidence was 5.42%.The univariate analysis showed that the occurrence of serum was related to the time of operation,the course of disease(more than 5 years),the location of hernia(bilateral hernia),the way of patch fixation(bio glue fixation).The inguinal pain questionnaire score of 1 and 3 months after operation was significantly higher in seroma patients(P<0.05).Logistic regression model was used to analyze the multivariate factors,the results showed that operation time and course of disease(more than 5 years)were independent risk factors for the occurrence of seroma.Conclusions:The occurrence of seroma after laparoscopic repair of inguinal hernia is related to the course of disease and excessive separation during operation.The hernia patch may not be fixed.During the operation,careful operation should be performed to minimize excessive dissection of hernia sac,so as to reduce bleeding and lymphatic damage,as well as the opening of residual hernia sac,can achieve the prevention of seroma and satisfactory results.