慢性肾功能衰竭腹膜透析患者合并腹股沟疝的治疗体会

Treatment of peritoneal dialysis patients with chronic renal failure complicated with inguinal hernia

目的总结慢性肾功能衰竭腹膜透析患者合并腹股沟疝的临床治疗经验。方法对30例行Lichtenstein无张力修补术的腹膜透析合并腹股沟疝患者进行回顾性分析,收集患者一般资料、手术时间、术中出血量、平均住院时间、术后并发症及预后情况。结果30例患者均顺利完成Lichtenstein无张力修补术,平均手术时间为(56.3±26.2)min,术中出血量(5.2±3.6)mL,平均住院时间(4.5±2.4)d。术后随访出现血清肿、慢性疼痛各1例,经保守治疗后症状好转。围术期中30例患者均采用临时中心静脉插管无肝素化血液透析作为过渡性透析治疗,术后2周逐渐恢复半量或全量腹透。术后随访6~72个月,未发现腹股沟疝复发。结论Lichtenstein无张力修补术疗效显著,术后并发症轻微,可作为腹膜透析患者合并腹股沟疝时的理想术式,而无肝素化血液透析可作为过渡性透析治疗的选择。

Objective To summarize the experiences in clinical treatment of peritoneal dialysis patients with chronic renal failure complicated with inguinal hernia.Methods A retrospective analysis was conducted on 30 peritoneal dialysis patients complicated with inguinal hernia who underwent Lichtenstein’s tension-free repair.The general data,operation time,intraoperative bleeding,average hospital stay,postoperative complications and prognosis of all patients were collected.Results All the 30 patients were successfully treated with Lichtenstein’s tension-free repair,with the mean operation time of(56.3±26.2)min,the intraoperative bleeding of(5.2±3.6)mL,and mean hospital stay of(4.5±2.4)d.There were 1 case of seroma and 1 case of chronic pain identified in postoperative follow-up,which were improved after conservative treatment.During the perioperative period,30 patients received heparin-free dialysis with temporary central venous catheterization as a transitional dialysis treatment,which was recovered to half or full volume of abdominal dialysis gradually in postoperative 2 weeks.The patients received postoperative follow-up for 6-72 months,and no recurrence of inguinal hernia has identified.Conclusion Lichtenstein’s tension-free repair has remarkable therapeutic effect with minimal postoperative complications.It is an ideal procedure for peritoneal dialysis patients complicated with inguinal hernias,and heparin-free hemodialysis can be an option for transitional dialysis treatment.