35例闭孔疝患者临床诊断和治疗分析

Analysis of clinical diagnosis and treatment of 35 patients with obturator hernia

目的对闭孔疝的临床特点、诊疗进行临床分析以总结经验,提高认识,改善预后。方法回顾性分析2010年1月至2023年8月,太仓市第一人民医院收治的35例闭孔疝患者的相关临床资料。并分层分析不同年龄、体重指数及身高患者的临床特点及治疗方法。结果35例患者均为老年女性,合并慢性病史者17例(48.6%),分层分析发现有慢性病史的患者比例在不同年龄组间差异有统计学意义(P=0.036),随着年龄的增大有慢性病史者的比例在逐渐增大,60~79岁患者中合并慢性病史者比例为36.4%,80~89岁患者中合并慢性病史者比例为47.6%,90岁以上患者中合并慢性病史者比例为100%;在不同体重指数组间差异也有统计学意义(P=0.009),体重指数在15.01~17.00 kg/m^(2)之间患有慢性病的患者比例最高,达72.7%。手术治疗32例,有9例因小肠坏死行部分小肠切除,1例行补片修补。其中12例(34.3%)因病情危重经ICU抢救治疗。经ICU治疗的患者比例在不同年龄组(P=0.096)间差异有统计学意义,其中在80~89岁年龄区间经ICU治疗者达47.6%,另外随着身高的增加经ICU治疗患者的比例有增加的趋势。其余3名患者行保守治疗。所有患者均痊愈出院,住院时间5~20 d,中位9 d。结论闭孔疝患者多为消瘦的老年女性且多合并慢性疾病,临床上危重症者较多。闭孔疝的延误诊治易导致肠坏死甚至危及患者生命,需要临床医生予以重视,尽早干预,以改善患者的预后。

Objective To analyze the clinical characteristics and treatment of obturator hernia in order to summarize experience,improve understanding and improve prognosis.Methods The clinical data of 35 patients with obturator hernia treated in the First People's Hospital of Taicang from January 2010 to August 2023 were retrospectively analyzed.The clinical characteristics and treatment methods of patients with different ages,body mass index and height were analyzed.Results All 35 patients were elderly women,and 17(48.6%)were complicated with chronic diseases.Stratified analysis showed that the proportion of patients with chronic diseases was significantly different between different age groups(P=0.036),and the proportion of patients with chronic diseases gradually increased with the increase of age.The proportion of patients with chronic diseases is 36.4%among patients aged 60-79,47.6%of patients with chronic diseases among patients aged 80-89,and 100%of patients with chronic diseases among patients over 90 years old.There was also a statistical difference between patients of different body mass index groups(P=0.009).The proportion of people with chronic diseases was highest in the body mass index range of 15.01-17.00 kg/m^(2),reaching(72.7%).32 patients underwent surgery and 9 required bowel resection due to intestinal necrosis,1 required mesh repair.Among them,12 patients(34.3%)underwent ICU treatment due to critical condition.The proportion of patients treated in the ICU was significantly different between different age groups(P=0.096).The proportion of patients treated in the ICU in the age range of 80-89 years was 47.6%.With the increase in height,the proportion of patients treated in the ICU also increased.The other three patients were treated conservatively.All patients were cured and discharged from the hospital.Hospitalization time was 5 to 20 days,with a median of 9 days.Conclusion The patients with obturator hernia are mostly elderly and emaciated female patients who often have chronic diseases,and there are many severe patients in the clinic.Delayed diagnosis and treatment of obturator hernia can lead to intestinal necrosis or even life-threatening complication,which requires clinicians to pay attention to and intervene as soon as possible to improve the prognosis of patients.