腹股沟疝无张力修补术后补片感染清创及伤口I期缝合治疗  

Can the wounds after infected meshes removal be sutured primarily： a retrospective study

作　　者：赵凤林[1] 秦昌富[1] 陈杰[1] 刘亦婷 王宝山[1] 孙立[1] 杨硕[1] 王帆[1] 刘素君[1] 申英末[1] Zhao Fenglin Qin Changfu Chen Jie Liu Yiting Wang Baoshan Sun Li Yang Shuo Wang Fan Liu Sujun Shen Yingmo.(Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100043, China)

机构地区：[1]首都医科大学附属北京朝阳医院疝和腹壁外科,100043

出　　处：《中华普通外科杂志》2017年第4期332-335,共4页Chinese Journal of General Surgery

摘　　要：目的评价腹股沟疝无张力修补术后补片感染行清创术及伤口I期缝合的治疗效果。方法回顾性分析2007年1月至2013年12月首都医科大学附属北京朝阳医院疝和腹壁外科收治的208例无张力腹股沟疝修补术后补片感染行清创术患者的临床资料。其中147例切口I期缝合，为缝合组；61例切口敞开换药，为开放组。对补片感染时间、细菌类型、切口愈合、平均住院时间、平均住院费用及疝复发等指标进行分析。结果所有感染病例的补片感染时间平均为（8．37±6．89）个月：细菌感染类型两组差异无统计学意义；缝合组中伤口甲级愈合率81．0％（119／147），开放组无甲级愈合。平均住院时间[（20．86±7．90）d比（31．82±11．50）d，t=3．47，P=0．034]，平均住院费用[（1．32±0．58）万比（2．65±0．66）万，t=4．51，P=0．02]，缝合组均少于开放组，差异有统计学意义；缝合组无疝复发，开放组1例疝复发；缝合组有6例二次行清创术，切口换药。所有患者经治疗后痊愈。结论腹股沟疝无张力修补术后补片感染应个体化处理；行清创术及伤口I期缝合者，愈合率高，平均住院时间短，住院费用低，疝复发率低。Objective To explore the efficacy of debridement and primary suture for mesh-related infections after tension-free inguinal hernia repair. Methods From January 2007 to December 2013, 208 cases with mesh infectious following inguinal hernia repairs were treated with debridement in Department of Hernia and Abdominal Wall Surgery of Beijing Chaoyang Hospital, 147 cases were treated with primary suture （suture group） and 61 cases were treated with dressing change （open group）. Results The mean time of mesh infection was （ 8.37 ± 6. 89 ） months. The results of bacterial culture in the two groups were similar. First grade healing rate of suture group was 80. 95% （ 119/147 ） , compared to zero percent in open group. Length of stay [ （20. 86 ±7.90） d vs. （31.82 ± 11.50） d,t = 3.47,P = 0. 034] and hospital cost [ （3 200 ±5 800） yuan vs. （26 500 ±6 600） yuan, t =4. 51, P =0. 02] in suture group were less than in open group. No patients developed recurrent hernia in suture group compared with one recurrence in open group. Conclusions Debridement and primary suture for mesh-related infections after tension-free inguinal hernia repair could increase the rate of first grade healing, shorten average length of hospital stay and reduce total costs.

关 键 词：疝 腹股沟 疝修补术 补片感染 清创术 I期缝合 

分 类 号：R656.21[医药卫生—外科学]