腹腔镜经腹腹膜前疝修补术后发生血清肿的影响因素研究

Study on influencing factors of seroma after laparoscopic preperitoneal tension-free inguinal hernia repair

目的探究腹腔镜经腹腹膜前疝修补术(TAPP)后发生血清肿的影响因素。方法采用回顾性队列研究的方法分析2019年12月—2022年12月于阜阳市第五人民医院行TAPP的320例腹股沟疝患者的临床资料,其中,男性226例,女性94例,年龄(61.46±10.22)岁,年龄范围23~76岁。根据患者术后是否发生血清肿分为血清肿组(n=18)和未发生组(n=302)。采用多因素Logistic回归分析筛选TAPP后发生血清肿的影响因素,并基于Softmax策略以二分类变量生存0(结局事件未发生)和1(结局事件发生)作为结果变量构建人工神经网络模型,采用受试工作者特征(ROC)曲线和累积增益图分析模型区分度和应用价值。正态分布的计量资料以均数±标准差(x±s)表示,组间比较采用独立样本t检验;计数资料组间比较采用χ^(2)检验。结果320例患者术后血清肿发生率为5.63%(18/320),其中Ⅰ型7例,Ⅱ型4例,Ⅲ型7例,经对症治疗后均已好转。多因素分析显示,合并基础疾病、服用抗凝血药物、病程、手术时间、术中出血量、疝囊直径、补片固定方式、中性粒细胞与淋巴细胞比值(NLR)是腹股沟疝患者TAPP无张力修补术后血清肿的影响因素(OR=1.732、2.414、2.346、1.480、2.159、1.725、1.248、2.179;95%CI:1.385~2.942、1.764~3.176、1.280~3.209、1.263~2.275、1.331~2.861、1.308~2.239、1.005~1.764、1.644~2.982;P<0.05)。ROC曲线和累积增益图表明所构建的人工神经网络模型可较好地预测患者术后血清肿发生的概率。结论腹股沟疝患者TAPP后血清肿的发生与合并基础疾病、服用抗凝血药物、病程、手术时间、术中出血量、疝囊直径、补片固定方式、NLR等多种因素有关,临床应重点关注这些问题,降低术后血清肿的发生率。

Objective To explore the influencing factors of seroma after transabdominal preperitoneal prosthetic(TAPP)inguinal hernia by laparoscopy.Methods A retrospective cohort study was used to analyze the clinical data of 320 patients with inguinal hernia who received TAPP in Fuyang Fifth People′s Hospital from December 2019 to December 2022,including 226 males and 94 females,with an average age of(61.46±10.22)years(range:23-76 years).Patients were divided into seroma group(n=18)and non-seroma group(n=302)according to whether seroma occurred after surgery.Multivariate Logistic analysis was used to screen the influencing factors of seroma after TAPP tension-free repair,and based on Softmax strategy,the artificial neural network model was constructed with binary classification variables survival 0(no outcome event occurred)and 1(outcome event occurred)as outcome variables.receiver operating characteristics(ROC)and cumulative gain graph were used to analyze the model differentiation and application value.The measurement data of normal distribution were expressed as mean±standard deviation(x±s),and independent sample t-test was used for comparison between groups.Chi-square test was used for comparison between count data groups.Results The incidence of postoperative seroma in 320 patients was 5.63%(18/320),including 7 cases of typeⅠ,4 cases of typeⅡ,and 7 cases of typeⅢ,all of which were improved after symptomatic treatment.Combined with underlying diseases,anticoagulant drugs,duration of disease,operation time,intraoperative blood loss,hernia sac diameter,mesh fixation method,neutrophil to lymphocyte ratio(NLR)were factors influencing seroma ofter TAPP in inguinal hernia patients(OR=1.732,2.414,2.346,1.480,2.159,1.725,1.248,2.179;95%CI:1.385-2.942,1.764-3.176,1.280-3.209,1.263-2.275,1.331-2.861,1.308-2.239,1.005-1.764,1.644-2.982;P<0.05).The ROC curve and cumulative gain graph showed that the artificial neural network model could well predict the probability of postoperative seroma.Conclusions The occurrence of seroma after TAPP tension-free repair in inguinal hernia patients is related to underlying diseases,taking anticoagulant drugs,course of disease,operation time,intraoperative blood loss,diameter of hernia sac,patch fixation method,NLR and many other factors.Clinical attention should be paid to these problems to reduce the incidence of postoperative seroma.