腹腔镜腹股沟疝修补术患者术后出血及二次手术相关因素分析  

The Analysis of Bleeding and Reoperation Related Factors in Patients of Laparoscopic Inguinal Hernia Repair

作　　者：邓芝徽[1] 邢壮杰[1] 赵晖[1] 李润生[1] 郑新[1] 郝国强[1] 

机构地区：[1]大连大学附属中山医院血管外科,辽宁大连116001

出　　处：《现代生物医学进展》2016年第9期1691-1694,共4页Progress in Modern Biomedicine

基　　金：辽宁省自然科学基金项目(2015021036)

摘　　要：目的:探讨影响腹腔镜腹股沟疝修补术患者术后出血及二次手术相关因素。方法:回顾性分析行腹腔镜腹股沟疝修补术的6632例患者的临床资料,将凝血病、抗凝治疗或抗血小板治疗的829例患者归入风险组(n=829),其他患者归为对照组(n=5803),收集并比较二组患者的手术方式、年龄、性别、美国麻醉师协会(ASA)分级、疝缺损面积(I-III级)、一期手术与二次手术等患者资料,进行一年随访;采用多变量分析影响患者继发性出血及并发症所致二次手术的相关因素。结果:风险组的术后出血发生率显著高于对照组(4.22%vs 1.26%,P<0.001),所有患者术后出血发生率为1.63%。影响术后继发性出血的其它负面因素有:开放式腹股沟疝术式、年龄增加、较高ASA分级、二次手术、男性和较大的疝缺损。风险组与并发症相关的二次手术发生率显著高于对照组(2.65%vs 1.14%,P<0.001),所有患者与并发症相关的二次手术发生率为1.32%。影响患者并发症所致二次手术负面因素有:双侧手术、较高ASA分级、凝血病与抗凝治疗和抗血小板治疗、高龄,保护因素包括:较小的疝缺损面积与腹腔镜手术式。结论:行腹腔镜腹股沟疝手术患者术后出血性及并发症相关的二次手术的风险小于行开放术式患者。Objective： To investigate the bleeding and reoperation related factors of patients after laparoscopic inguinal hernia repair operation. Methods： We retrospective analyzed the clinical data of 6632 patients who got laparoscopic inguinal hernia repair. The829 patients who were treated with coagulopathy, anticoagulation or antiplatelet were classified as risk group（n=829）. The other patients were classified as the control group（n=5803）. Collect and compare the clinical data including surgical approach（laparoscopic/open）, age,sex, American Society of Anesthesiologists（ASA） score, hernia defect area（ I-III level）, a surgical operation and reoperation. Follow up for a year. We used multivariate analysis to investigate the related factors for laparoscopic inguinal hernia repair patients with postoperative bleeding and reoperation. Results： The incidence of postoperative bleeding in risk group was significantly higher than in control group（4.22% vs 1.26%, P〈0.001）. The rate of postoperative bleeding occurred in all patients was 1.63%. Other negative factors affecting postoperative secondary bleeding included open inguinal hernia procedure, increasing age, a higher ASA classification, the second surgery, the male and the larger hernia defect. The rate of reoperation related with complications in risk group was significantly higher than in control group（2.65% vs 1.14%, P〈0.001）, and the rate of reoperation related with complications was 1.32% in all patients. The negative factors for complications-caused reoperation in patients included bilateral surgery, a higher ASA classification, coagulopathy and anticoagulant therapy and antiplatelet therapy, elderly. The protective factors included a small hernia defect area and laparoscopic surgery formula. Conclusion： The risk of postoperative bleeding and complications-associated second surgery is less for patients with laparoscopic inguinal hernia surgery than open surgical patients.

关 键 词：疝气 术后出血 二次手术 

分 类 号：R656.2[医药卫生—外科学] R619.1[医药卫生—临床医学]