高龄病人腹外嵌顿疝合并肠坏死的诊疗体会

Diagnosis and treatment of incarcerated hernia in elderly patients with intestinal necrosis

目的 :探讨高龄腹外嵌顿疝合并肠坏死的可能原因及治疗。方法 :回顾分析我科2013年1月至2017年12月收治的20例80岁以上腹外嵌顿疝合并肠坏死病人的临床资料。所有病人均行急诊手术治疗。术中证实为肠坏死并行肠切除吻合术,术中应用无张力疝修补术2例,传统Bassini修补术18例。常规在腹外斜肌腱膜下放置引流管。结果:20例病人手术均顺利完成。2例分别术后第5、11天因肺部感染死亡。其余18例治愈出院。术后随访无复发,无补片感染等并发症发生。随访期间5例死亡。结论:高龄病人嵌顿疝伴肠坏死的手术治疗总体成功。早期诊断及预防肺部感染具有积极作用。

Objective To investigate the cause and treatment of incarcerated hernia in elderly patients with intestinal necrosis.Methods A retrospective study was conducted using the data of 20 elderly patients more than 80 years old with incarcerated hernia combined with intestinal necrosis from January 2013 to December 2017 in our department.Emergency surgery was performed for all cases.Intestinal necrosis was diagnosed operatively and intestinal resection was performed combined with intestinal anastomosis.Two cases were processed with tension-free hernia repair and the other 18 cases were operated with Bassini repair.Drainage was placed under external abdominal oblique muscle fascia.Results The operation was completed successfully for all patients.Two patients died of pulmonary infection on postoperative 5 day and11 day,respectively.The other patients were cured.During the period of postoperative follow-up,neither complication nor recurrence was found.Conclusions Surgical treatment could be considered as safe procedure for elderly patients with incarcerated hernia combined with intestinal necrosis.Early diagnosis and active prevention of pulmonary infection have positive effects on the prognosis of elderly patients.