腹壁切口疝分型与手术前后腹腔压力的相关性

The correlation analysis between abdominal incisional hernia classification and abdominal pressure before and after operation

目的分析腹壁切口疝分型与手术前后腹腔压力变化压力的相关性。方法选择2021年9月至2022年9月四川大学华西医院胃肠疝和腹壁外科确诊为切口疝并行手术修补的48例患者进行回顾性研究。通过腹部CT测量疝环大小联合三维重建计算疝囊/腹腔容积比进行分型,并记录手术前后不同时间点腹腔压力、心率、呼吸频率、氧饱和度、平均动脉压及尿量。采用Spearman秩相关系数分析疝环长径和腹腔/疝囊容积比的相关性。结果48例患者中型疝13例,大型疝19例,巨大疝16例。疝环长径6~25 cm,平均(11.53±3.79)cm;手术时间(73.5±8)min;疝环大小与疝囊/腹腔容积比相关性分析呈正相关(r=0.669,P<0.001);中型疝,大型疝及巨大型疝组术后48 h最高腹腔压力分别为(11.90±1.90)、(15.00±3.00)、(22.25±2.00)mmHg,提示腹腔压力逐渐升高;肛门排气时间分别为(14.80±2.50)、(17.50±2.00)、(24.00±3.00)h,提示排气时间延迟;术后24 h尿量分别为(1565.92±149.56)、(1285.05±124.87)、(1173.56±48.29)ml,提示尿量逐渐减少,3组差异均有统计学意义(P<0.05);3组间在术前麻醉完成后、麻醉清醒时、术后24 h、术后48 h,3组呼吸频率、心率、氧饱和度及平均动脉压,经过LSD检验,差异均无统计学意义(P>0.05)。结论切口疝术后腹腔压力增高、切口疝分型与术后腹腔压力关系密切,切口疝手术精确分型、术后监测腹腔压力对预防和应对腹腔间室综合征等并发症具有临床意义。

Objective To analyze the correlation between abdominal wall incisional hernia typing and the pressure of abdominal pressure changes before and after surgery.Methods Forty-eight patients diagnosed with incisional hernia and surgical repair in the Department of Gastrointestinal Hernia and Abdominal Wall Surgery of West China Hospital of Sichuan University from September 2021 to September 2022 were selected for retrospective study.The hernia ring size was measured by abdominal CT combined with three-dimensional reconstruction to calculate the hernia sac/abdominal cavity volume ratio for staging,and abdominal pressure,heart rate,respiratory rate,oxygen saturation,mean arterial pressure,and urine output were recorded at different time points before and after surgery.Spearman's rank correlation coefficient was used to analyze the correlation between the hernia ring length diameter and the abdominal cavity/hernia sac volume ratio.Results Thirteen medium-sized hernias,19 large hernias,and 16 giant hernias were found in 48 patients.Hernia ring length and diameter ranged from 6 to 25 cm,with a mean of(11.53±3.79)cm;operative time(73.5±8)min;the correlation analysis between hernia ring size and hernia sac/abdominal cavity volume ratio showed a positive correlation(r=0.669,P<0.001);the highest abdominal pressures in the medium-sized hernia,large hernia,and giant hernia groups at 48 h postoperatively were(11.90±1.90),(15.00±3.00),(22.25±2.00)mmHg,respectively,suggesting a gradual increase in abdominal pressure;the time of anal defecation was(14.80±2.50),(17.50±2.00),(24.00±3.00)h,suggesting a delay in the time of defecation;the 24-hour postoperative urine volume was(1565.92±149.56),(1285.05±124.87),(1173.56±48.29)ml,suggesting a gradual decrease in urine output,and the differences between the three groups were statistically significant(P<0.05);between the three groups after the completion of preoperative anesthesia,when anesthesia was awake,24 h postoperative,48 h postoperative,respiratory rate,heart rate,oxygen saturation and mean arterial pressure of the three groups,and the differences were not statistically significant after LSD test(P>0.05).Conclusion Increased abdominal pressure after incisional hernia surgery,incisional hernia staging and postoperative abdominal pressure are closely related,and precise staging of incisional hernia surgery and postoperative monitoring of abdominal pressure are of clinical significance in preventing and coping with complications such as abdominal compartment syndrome.