腹壁切口疝修补术后复发相关因素分析

Analysis of related factors of recurrence after abdominal incisional hernia repair

目的探讨腹壁切口疝修补术后复发的发生率及其相关危险因素。方法回顾性收集2015年1月至2019年12月期间,陕西省人民医院普通外科收治的213例腹壁切口疝患者的临床资料,分析腹壁切口疝术后复发情况及其相关影响因素。结果213例患者均接受了完整随访,随访时间3~60个月,中位随访时间为46个月;腹壁切口疝修补术后疝复发者24例(11.27%)。单因素分析结果显示:体质量指数(body mass index,BMI)、疝环大小、嵌顿、复发疝、腹部多次手术史、术后切口并发症、有腹压升高因素以及是否使用补片与腹壁切口疝修补术后的复发有关(P<0.05)。进一步行logistic多因素分析显示:BMI[OR=1.14,95%CI为(1.01,1.29),P=0.040]、嵌顿[OR=8.94,95%CI为(1.94,40.98),P=0.005]、复发疝[OR=10.91,95%CI为(2.09,56.84),P=0.005]和疝环大小[OR=1.15,95%CI为(1.03,1.28),P=0.010]与腹壁切口疝修补术后复发相关(P<0.05)。结论影响腹壁切口疝修补术后疝复发的危险因素有复发疝、嵌顿疝、疝环大小和BMI。对具有高危因素患者应采取相应的预防疝复发的措施。

Objective To explore the incidence of postoperative recurrence of abdominal incisional hernia and its related risk factors.Methods The clinical data of 213 patients with abdominal incisional hernia treated in the General Surgery of Shaanxi Provincial People’s Hospital from January 2015 to December 2019 were collected retrospectively,and the incidence of postoperative recurrence of abdominal incisional hernia and its related influencing factors were analyzed.Results A total of 213 patients underwent a complete follow-up.The follow-up time was 3 to 60 months,and the median follow-up time was 46 months.A total of 24 cases(11.27%)of hernia recurred after surgery.The univariate analysis results showed that body mass index(BMI),hernia ring size,incarceration,recurrent hernia,history of multiple abdominal operations,postoperative incision complications,factors such as increased abdominal pressure,and whether the patch were used for postoperative recurrence of abdominal incisional hernia influences(P<0.05).Further logistic multi-factor analysis results showed that BMI[OR=1.14,95%CI(1.01,1.29),P=0.040],incarcerated hernia[OR=8.94,95%CI(1.94,40.98),P=0.005],recurrent hernia[OR=10.91,95%CI(2.09,56.84),P=0.005],and hernia ring size[OR=1.15,95%CI(1.03,1.28),P=0.010]were related to the recurrence of abdominal incisional hernia after surgery(P<0.05).Conclusions The risk factors for hernia recurrence after abdominal incisional hernia repair include recurrent hernia,incarcerated hernia,hernia ring size,and BMI.For patients with high-risk factors,corresponding measures should be taken to prevent hernia recurrence.