凝血功能异常腹股沟疝病人治疗策略

Treatment strategy for patients of inguinal hernia with abnormal coagulation function

腹股沟疝是外科最常见的疾病之一,巨大复杂的腹股沟疝手术创伤也较大,容易出现术中和术后出血。另外,腹股沟疝病人的老龄化发展,也存在一部分病人因为心脑血管疾病使用抗凝药物,导致出血风险进一步增加,但盲目停用抗凝药物,又可能出现血栓形成。因此,腹股沟疝手术与凝血功能有重要联系,引起重视。凝血功能异常表现在凝血因子量的变化或功能异常所致出血和血栓性疾病。凝血功能不足导致出血风险,而凝血功能亢进则表现为血栓形成。凝血异常和病人遗传、药物、手术创伤、麻醉有一定的关系。针对出血性的凝血功能障碍,需要术前重点检测并给以术前相关的处理,尽量调整凝血功能至正常,减少术中出血,维持手术的安全。而血栓性凝血功能障碍,主要注意合理用药,在不增加出血的情况下尽可能的缩短无抗凝药物的窗口期,减少血栓形成的风险。因此,针对腹股沟疝病人,应在降低出血风险同时也要减少血栓形成的风险,找到血栓形成和出血风险之间的最佳平衡点。

Inguinal hernia is one of the most common diseases in surgery.The surgical trauma of a huge and complex inguinal hernia is relatively large,which is prone to intraoperative and postoperative bleeding.In addition,with the aging development of inguinal hernia patients,some patients also use anticoagulant drugs due to cardiovascular and cerebrovascular diseases,which further increases the risk of bleeding.However,blind withdrawal of anticoagulant drugs may cause thrombosis.Therefore,inguinal hernia operation has an important relationship with coagulation function,which should be paid attention to.Abnormal coagulation function is manifested in bleeding and thrombotic diseases caused by changes in the amount of coagulation factor or abnormal function.Under coagulation leads to the risk of bleeding,while hyper coagulation manifests as thrombosis.These coagulation abnormalities and patient’s genetics,drug,surgical trauma,and anesthesia have a certain relationship.For hemorrhagic coagulopathy,preoperative key detection and relevant treatment are needed to adjust the coagulopathy to normal as far as possible,reduce intraoperative bleeding,and maintain the safety of the operation.For thrombotic coagulopathy,attention should be paid to rational drug use to shorten the window period without anticoagulant drugs as much as possible without increasing bleeding,so as to reduce the risk of thrombosis.Therefore,for patients with inguinal hernia,the optimal balance between the risk of thrombosis and the risk of bleeding should be found while reducing the risk of bleeding.