合并失代偿性肝硬化腹股沟疝Lichtenstein手术疗效观察

Clinical observation of Lichtenstein's operation for inguinal hernia with decompensated cirrhosis

目的探讨合并失代偿性肝硬化的腹股沟疝患者行Lichtenstein手术疗效。方法回顾性分析2015年1月至2018年12月阜阳市第二人民医院收治的98例合并失代偿性肝硬化的腹股沟疝行Lichtenstein手术治疗患者临床资料。结果98例患者均顺利完成手术。手术时间为40~75 min,平均时间为(52.55+6.23)min;住院时间4~14 d,平均住院时间(5.89+1.99)d。未见补片感染、腹水渗漏等并发症。切口脂肪液化4例,通过适当引流、换药等处理痊愈出院。阴囊积液、切口皮下瘀斑8例,自行吸收。下腹及会阴部广泛渗血伴尿潴留1例,输注新鲜血浆、保留导尿、预防感染治疗后痊愈出院。术后随访3个月,未见复发,疼痛4例,逐渐减轻未做特殊处理。1例既往行脾切除+贲门周围血管离断术后1年余,术后第15天患者出现门静脉血栓致回肠部分坏死,再次手术行小肠部分切除术,术后予以溶栓、祛聚、抗凝后痊愈。结论合并失代偿性肝硬化的腹股沟疝局麻下行Lichtenstein手术治疗安全、有效、经济,值得临床推广。

Objective To explore the effect of Lichtenstein operation on inguinal hernia patients with decompensated cirrhosis.Methods The clinical data of 98 cases of inguinal hernia with decompensated cirrhosis treated by Lichtenstein operation from January 2015 to December 2018 in Fuyang Second People's Hospital were analyzed retrospectively.Results All the 98 patients completed the operation successfully.The operating time was 40 to 75 minutes,and the average time was(52.55±6.23)minutes;The average hospital stay was(5.89±1.99)days(range from 4 to 14 days).No complications such as mesh infection and ascites leakage were found.Incision fat liquefaction was found in 4 cases,which cured and discharged through appropriate drainage,dressing change and other treatment.8 cases of scrotal effusion and subcutaneous ecchymosis of incision occurred,and they were absorbed spontaneously.One patient with extensive lower abdominal bleeding and urinary retention,and he was discharged after infusion of fresh plasma,retention of catheterization and infection prevention treatment.After 3 months of follow-up after operation,no recurrence was found,and 4 cases of pain were gradually relieved without special treatment.One case of partial ileal necrosis caused by portal vein thrombosis occurred on the 15th day after surgery,and the patient had the history of splenectomy and pericardial devascularization one year ago.And the patient underwent partial resection of small intestine,thrombolysis,deaggregation and anticoagulation.Conclusion Lichtenstein's operation under local anesthesia for inguinal hernia with decompensated cirrhosis is safe,effective and economical,and it is worthy of clinical promotion.