四种远端疝囊处理方法预防腹股沟阴囊疝术后血清肿的效果比较

Clinical study on four methods treating distal hernia sac to prevent the postoperative seroma of inguinal scrotal hernia

目的比较四种远端疝囊处理方法,减少腹股沟阴囊疝无张力修补术后血清肿的发生。方法纳入2015年1月~2018年12月上海交通大学附属第六人民医院东院腹股沟阴囊疝开放疝修补手术患者共247例。按照远端疝囊处理方式不同,将入组患者随机分为A组51例(行远端疝囊旷置)、B组77例(行远端疝囊旷置+开窗术)、C组53例(行远端疝囊旷置+残腔作连续螺旋内荷包缝扎)、D组66例(行远端疝囊内面予2%石碳酸烧灼)。随访时记录术后血清肿等并发症情况。结果四组患者在年龄分布、体重指数、疝分型、疝修补方式等资料进行比较差异无统计学意义(均P>0.05)。四组患者术后睾丸萎缩例数进行比较,差异有统计学意义(P<0.05);组间两两比较发现,B、C两组比较差异有统计学意义(P=0.020);D、C两组比较差异有统计学意义(P=0.004);C组导致睾丸萎缩的可能性更高一些。四组患者术后第7天、术后1月和术后3月疼痛评分进行比较,差异均有统计学意义(均P<0.05);术后第七天,A组与B组疼痛评分比较差异无统计学意义(P=0.638),C组与D组疼痛评分比较差异无统计学意义(P=0.891),其他组间疼痛评分两两比较差异均有统计学意义(均P<0.05);AB两组疼痛评分高于CD两组,AB两组比CD两组的疼痛程度更大一些。在术后1月和术后3月,AB两组比CD两组的疼痛程度更大一些。四组患者术后血清肿例数比较差异有统计学意义(P<0.001),组间两两比较发现,A、B两组比较差异无统计学意义(P=0.880),C、D两组比较差异无统计学意义(P=0.909),其他组间两两比较的差异均有统计学意义(均P<0.05)。AB两组术后血清肿例数高于C+D两组,A+B两组比C+D两组发生术后血清肿的可能性更大一些。结论与远端疝囊旷置和远端疝囊旷置+开窗相比,远端疝囊内面石碳酸搽拭与远端疝囊旷置+残腔作连续螺旋内荷包缝扎能减少术后第7天、术后1月和术后3月的术后疼痛评分,能减少术后血清肿的发生,而远端疝囊旷置+残腔作连续螺旋内荷包缝扎可能会增加术后睾丸萎缩的风险。

Objective In order to reduce the occurrence of seroma after Inguinal scrotal hernia surgery,four clinical methods treating the distal hernia sac were researched.Methods From January 2015 to December 2018,a total of 247 patients with inguinal scrotal hernia were included in the study,and randomly divided into four groups,according to the different distal hernia sacs processing methods.Control group A contained 51 cases,whose distal hernia sacs were not treated.Group B contained 77 cases,whose distal hernia sacs were fenestrated.Group C contained 53 cases,whose remote hernia sacs were internally continuously spirally sutured.Group D contained 66 examples,whose distal hernia sacs were burned.with 2%phenol.Postoperative complications such as seroma were recorded during follow-up.Results The differences of patients’age distribution,body mass index,hernia type,and hernia repair methods among the four groups were not statistically significant.The number of patients with testicular atrophy after herniorrhaphy among the four groups was statistically significantly different(P<0.05,P=0.028).The difference between group B and Group C was statistically significant(P=0.020).The difference between group D and Group C was statistically significant(P=0.004).The probability of testicular atrophy was higher in group C.Patients’postoperative pain score at the seventh day,1 month or 3 month after surgery among four groups were statistically significantly differently(P<0.05,P=0.003,<0.001,<0.001).At the seventh day after surgery,the difference between group A and group B was not statistically significant(P=0.638).The difference between group C and group D was not statistically significant(P=0.891).The difference between the other groups had statistical significance(P<0.05,respectively,P=0.027,0.028,0.004,0.003).Pain scores in group A or group B were higher than those in group C or group D,and pain in group A or group B were more severe than that in group C or group D.Similarly,in one month or three months after surgery,Pain scores in group A or group B were higher than those in group C or group D,and pain in group A or group B were more severe than that in group C or group D.The number of patients with seroma after herniorrhaphy was compared among the four groups,and the difference was statistically significant(P<0.05,P<0.001).The difference between group A and group B was not statistically significant(P=0.880).The difference between group C and group D was not statistically significant(P=0.909).The difference between the other groups had statistical significance(P<0.05,respectively,P=0.002,0.003,0.002,0.003).Seroma cases in group A or group B were higher than those in group C or group D.The probability of postoperative seroma in group A or group B was higher than that in group C or group D.Conclusion Compared with distal hernia sacs not being treated,or distal hernia sacs being fenestrated,distal hernia sacs being internally continuously spirally sutured or being burned with 2%phenol can reduce postoperative pain score in postoperative day 7,postoperative 1 month or 3 months,can reduce the occurrence of postoperative seroma,and distal hernia sacs being internally continuously spirally sutured may increased the risk of postoperative testicular atrophy.