无张力腹股沟疝修补术后补片感染的探讨  

Mesh Infection in Tension-free Hernioplasty

作　　者：唐黎明[1] 费晓舟[1] 孙一峰[1] 马玉亮[1] 王国华[1] 黄洪亮[1] 

机构地区：[1]绍兴市人民医院疝外科,312000

出　　处：《中华疝和腹壁外科杂志（电子版）》2013年第2期64-67,共4页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

摘　　要：目的探讨疝补片感染的发病原因、预防和治疗方法。方法回顾性分析2009年1月至2012年7月绍兴市人民医院疝外科收治的7例使用补片行无张力腹股沟疝修补手术后发生切口感染的患者临床资料。其中行腹膜前间隙修补3例,疝环填充式无张力疝修补术1例,平片修补术3例。应用单纯聚丙烯补片5例,其中轻量聚丙烯3例;聚四氟乙烯材料1例,聚酯材料1例。根据感染的程度、材料不同采用相应的治疗方法。全部去除补片2例;部分去除补片2例;开放换药3例。部分去除补片者予持续负压真空引流,完全去除补片者均予一期缝合,封闭式引流。结果全组患者均治愈出院,无围手术期死亡,手术后无疼痛和尿潴留。1例补片完全取出者切口有渗出,经换药后二期愈合,换药时间7d至6个月,中位时间4周,选择性使用抗生素3～14d,平均7.5d,随访时间2～42个月,平均18.5个月,部分或完全取出补片的患者未见疝复发。结论补片感染应以预防为重,采用个体化治疗方法,根据不同的手术类型和材料选择不同的治疗措施。Objective To evaluate the prevention and treatment of prosthetic mesh infections in tension-free hernioplasty. Methods The clinical date of 7 incision infections admitted from January 2009 to July 2012 were analyzed retrospectively. 3 cases were repaired by a bilayer mesh（ Prolene Hernia System）. 1 case was repaired with Mesh plug and 3 cases were repaired with an onlay mesh. As for the material used there were flat knitted polypropylene in 5 cases, polytef in 1 case and polyester in 1 case. Treatments were based on prothetic materials and the status of infection. Infectious meshes were removed completely in 2 cases and partially removed in 2 cases. Open dress change with meshes left in situ in 3 cases. 2 cases of removed meshes were given immediate to saturate with closed drainage. 2eases of partially removed mesh were drained by vacuum sealing drainage. Results Infection was cured in all cases without mortality. There was no hemor- rhage and injury of bladder during the procedures. No retention of urine, pain and other complications during postoperation. Change of dressing was made from 7 days to 6 months （average 4 weeks）. Selected antibiotic was used from 3 to 14 days（ average 7.5 days）. All patients were followed up from 2 to 42 months （ average 18.5 months） without hernia recurrence and infection. Conclusions It was most important to prevent infec- tions after tension-free hernioplasty. Management should be individualized according to different type of mesh used and the surgical procedure in hernia repair.

关 键 词：疝 腹股沟 感染 手术后并发症 聚丙烯类 

分 类 号：R656.2[医药卫生—外科学]