腹股沟疝无张力修补术后肠外瘘发生的危险因素分析  

Analysis of risk factors for postoperative enterocutaneous fistula after inguinal hernia free tension repair

作　　者：储诚兵[1] 陈杰[1] 申英末[1] 刘素君[1] 杨硕[1] 刘静[1] 曹金鑫[1] 邹振玉 Chu Chengbing;Chen Jie;Shen Yingmo;Liu Sujun;Yang Shuo;Liu Jing;Cao Jinxin;Zou Zhenyu(Department of Hernia and Abdominal Wall Surgery,Beijing Chao Yang 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：《中华消化外科杂志》2019年第11期1054-1059,共6页Chinese Journal of Digestive Surgery

基　　金：北京市医院管理局扬帆计划(XMLX201602)。

摘　　要：目的探讨影响腹股沟疝无张力修补术后肠外瘘发生的危险因素。方法采用回顾性病例对照研究方法。收集2015年1月至2018年9月首都医科大学附属北京朝阳医院收治的679例行腹股沟疝无张力修补术患者的临床资料;男646例,女33例;年龄为(65±12)岁,年龄范围为28~94岁。观察指标:(1)腹股沟疝无张力修补术情况。(2)随访情况。(3)肠外瘘及其治疗情况。(4)影响腹股沟疝无张力修补术后肠外瘘发生的危险因素分析。采用门诊和电话方式进行随访,了解患者术后肠外瘘情况。随访时间截至2019年6月。正态分布的计量资料以Mean±SD表示。计数资料以绝对数表示。单因素分析采用χ^2检验,多因素分析采用Logistic回归模型。结果(1)腹股沟疝无张力修补术情况:679例腹股沟疝患者均行无张力修补术。679例患者中,215例行网塞修补术或网塞 平片修补术,其中单纯Plug术9例、Millikan术50例、Rutkow术156例;464例患者行非网塞修补术,其中Lichtenstein术181例、经腹股沟腹膜前疝修补术53例、经腹腹膜前修补术(TAPP)及完全腹膜外腹股沟疝修补术230例。679例患者手术均使用聚丙烯修补材料,手术时间为(61±14)min,术中出血量为(10±7)mL。679例患者中,580例术后预防性使用抗菌药物。(2)随访情况:679例患者腹股沟疝无张力修补术后均获得随访,随访时间为15~86个月,中位随访时间为51个月。679例患者中,术后发生肠外瘘12例,均为男性,年龄为(69±8)岁,年龄范围为57~79岁;12例肠外瘘患者出现症状时间为(42±25)个月。(3)肠外瘘及治疗情况:12例发生肠外瘘患者腹股沟疝无张力修补术方式为网塞修补术或网塞 平片修补术11例、TAPP 1例(腹膜前平片侵蚀肠管形成肠外瘘)。皮肤瘘口均位于腹股沟区,瘘口直径为0.5~1.0 cm。12例肠外瘘患者中,5例乙状结肠瘘,其中4例行瘘口周围肠管切除术,1例行远端肠管闭合+近端结肠造瘘术Objective To analyze the risk factors for postoperative enterocutaneous fistula after inguinal hernia free tension repair.Methods The retrospective case control study was conducted.The clinical data of 679 patients who underwent inguinal hernia free tension repair between January 2015 and September 2018 in Beijing Chao Yang Hospital of Capital Medical University were collected.There were 646 males and 33 females,aged(65±12)years,with a range from 28 to 94 years.Observation indicators:(1)surgical situations of inguinal hernia free tension repair;(2)follow up;(3)enterocutaneous fistula and its treatment;(4)risk factors for postoperative enterocutaneous fistula after inguinal hernia free tension repair.Follow up by outpatient examination and telephone interview was performed to detect the postoperative enterocutaneous fistula up to June 2019.Measurement data with normal distribution were represented as Mean±SD.Count data were described as absolute numbers.Univariate analysis and multivariate analysis were done using the chi square test and Logistic regression model,respectively.Results(1)Surgical situations of inguinal hernia free tension repair:679 patients underwent inguinal hernia free tension repair.Of 679 patients,215 underwent plug repair or mesh plug repair,including 9 cases undergoing Plug repair only,50 undergoing Millikan procedure,and 156 undergoing Rutkow procedure,other 464 underwent non plug surgery,including 181 undergoing Lichtenstein procedure,53 undergoing transinguinal preperitoneal hernia repair(TIPP),and 230 undergoing transabdominal preperitoneal patch repair(TAPP)and total extraperitoneal inguinal hernia repair(TEP).Polypropylene mesh or plug were used in all 679 cases.The operation time and volume of intraoperative blood loss were(61±14)minutes and(10±7)mL.There were 580 of 679 patients treated with prophylactic antibiotics.(2)Follow up:679 patients were followed up for 15-86 months,with a median time of 51 months.There were 12 male patients with postoperative enterocutaneous fistula,aged

关 键 词：疝 腹股沟疝 无张力修补术 网塞 肠外瘘 危险因素 

分 类 号：R65[医药卫生—外科学]