经腹腹膜前疝修补术后腹内疝性肠梗阻的发生情况及其影响因素分析

Analysis of the occurrence and influencing factors of intra-abdominal herniated intestinal obstruction after TAPP operation

目的分析腹腔镜经腹腹膜前疝修补术(TAPP)后腹内疝性肠梗阻的发生情况及其影响因素。方法选取2018年1月至2021年12月北京同仁医院收治的404例腹股沟疝行TAPP术后患者作为研究对象,根据腹内疝性肠梗阻的发生情况将其分为发生组(38例)和未发生组(366例),分析所选腹股沟疝行TAPP术后患者的临床资料,采用单因素和Logistic回归分析筛选腹股沟疝患者行TAPP术后发生腹内疝性肠梗阻的影响因素。结果404例患者术后发生腹内疝性肠梗阻38例(9.41%);2组患者临床资料对比显示年龄、体质量指数(BMI)、疝囊直径、是否嵌顿疝、手术时间以及术中出血量等资料比较,差异均有统计学意义(均P<0.05);Logistic回归分析结果表明,BMI>24 kg/m^(2)(OR=3.278,95%CI:1.561~6.886,P=0.002)、疝囊直径>5 cm(OR=3.353,95%CI:1.602~7.022,P=0.001)、嵌顿疝(OR=3.208,95%CI:1.546~6.657,P=0.002)、手术时间>100 min(OR=2.437,95%CI:1.174~5.058,P=0.017)、术中出血量>10 ml(OR=2.733,95%CI:1.303~5.735,P=0.008)是TAPP术后发生腹内疝性肠梗阻的独立危险因素。结论BMI>24 kg/m^(2)、疝囊直径>5 cm、嵌顿疝、手术时间>100 min、术中出血量>10 ml是TAPP术后发生腹内疝性肠梗阻的独立危险因素,医务人员可以通过危险因素尽早识别高风险患者,还可对可以控制的危险因素给予一定的干预措施,以最大能力防止腹内疝性肠梗阻的发生。

Objective To analyze the occurrence and influencing factors of intra-abdominal herniated intestinal obstruction after laparoscopic transabdominal preperitoneal hernia repair(TAPP).Methods A total of 404 patients with inguinal hernia who underwent TAPP in our hospital from January 2018 to December 2021 were selected as the research subjects,and they were divided into the occurrence group according to the occurrence of intra-abdominal herniated intestinal obstruction(n=38).The clinical data of selected patients with inguinal hernia after TAPP and the non-incident group(n=366)were analyzed,and univariate and Logistic regression analysis was used to screen the influencing factors of intra-abdominal herniated intestinal obstruction in patients with inguinal hernia after TAPP.Results A total of 404 patients with inguinal hernia who underwent TAPP were included in this study.Among them,38 patients had intra-abdominal herniated intestinal obstruction after operation,and the incidence rate was 9.41%.The comparison of clinical data between the two groups showed that the age,body mass index(BMI),diameter of hernia sac,incarcerated hernia,operation time and intraoperative blood loss were compared,and the differences were statistically significant(P<0.05);Logistic regression analysis showed that BMI>24 kg/m^(2)(OR=3.278,95%CI:1.561-6.886,P=0.002),hernia sac diameter>5 cm(OR=3.353,95%CI:1.602-7.022,P=0.001),incarcerated hernia(OR=3.208,95%CI:1.546-6.657,P=0.002),operation time>100 min (OR=2.437, 95% CI: 1.174-5.058, P=0.017), intraoperative blood loss>10 ml (OR=2.733, 95% CI: 1.303-5.735, P=0.008) intra-abdominal hernia after TAPP independent risk factors for intestinal obstruction. Conclusion BMI>24 kg/m^(2), diameter of hernia sac>5 cm, incarcerated hernia, operation time>100 min, intraoperative blood loss>10 ml are independent risk factors for intra-abdominal hernia ileus after TAPP operation. To identify high-risk inguinal hernia patients as soon as possible with laparoscopic TAPP while also providing certain intervention measures to controllable risk factors to prevent the occurrence of intra-abdominal herniated intestinal obstruction to the greatest extent possible.