腹腔镜经腹腹膜前疝修补术后血清肿的相关因素及预测指标分析  

Analysis of the related factors and predictive indexes of seromas after laparoscopic trans-abdominal preperitoneal hernia repair

作　　者：莫佳丽 解基良[2] 张楠[2] 张兴洲[2] 董国强 MO Jiali;XIE Jiliang;ZHANG Nan;ZHANG Xingzhou;DONG Guoqiang(Tianjin Medical University,Tianjin 300070,China;Department of Gastrointestinal HerniaSurgery,Tianjin Hospital of ITCWN Nankai Hospital,Tianjin 300100,China;Department of Hepatobiliary and Gastrointestinal Surgery,Tianjin 4th Centre Hospital,Tianjin 300140,China)

机构地区：[1]天津医科大学,300070 [2]天津市南开医院胃肠疝外科,300100 [3]天津市第四中心医院肝胆胃肠外科,300140

出　　处：《重庆医学》2020年第13期2143-2147,共5页Chongqing medicine

摘　　要：目的探讨腹腔镜经腹腹膜前疝修补术(TAPP)术后血清肿的相关影响因素、预测指标及防治措施。方法回顾性分析2018年1月至2019年4月于天津市南开医院行TAPP治疗的295例患者临床资料,观察术后血清肿的发生情况,分析其相关因素及预测指标,并探讨防治措施。结果术后16例患者发生血清肿,发生率为5.4%,予观察、中药芒硝外敷及口服防己黄芪汤等治疗后均恢复良好。患者病程、合并症、疝的分型、术前血清总蛋白、清蛋白、中性粒细胞/淋巴细胞比值(NLR)、术中出血量及疝囊直径与术后血清肿的发生相关(P<0.05),其中病程大于1年、服用抗凝血药物、NLR>2、疝囊直径大于5 cm、术中出血量大于10 mL是TAPP术后发生血清肿的危险因素。绘制受试者工作特征(ROC)曲线,计算NLR曲线下面积为0.739,预测血清肿的临界值为1.99。结论TAPP术后血清肿的发生与多种因素相关,术前NLR对血清肿有一定预测作用,可针对相关危险因素及术前预测开展相应的防治措施。Objective To explore the relative factors,predictive indexes and prevention measures of seroma after laparoscopic trans-abdominal preperitoneal hernia repair(TAPP).Methods The clinical data of 295 cases of patients who underwent TAPP treatment at Tianjin Hospital of ITCWN Nankai Hospital from January 2018 to April 2019 were retrospectively analyzed.The occurrence of postoperative seroma was observed,related factors and predictive indexes were analyzed,and preventive measures were discussed.Results Sixteen patients had seroma after operation,the incidence rate of seroma was 5.4%,and the symptoms were improved after observation,external application of mirabilite,taking Fangji Huangqi Decoction and other treatments.The duration of disease,preoperative complications,severity of hernia,preoperative total serum protein and albumin,neutrophil-to-lymphocyte ratio(NLR),intraoperative blood loss and diameter of hernia sac were related to the occurrence of postoperative seroma(P<0.05).Additionally,duration of disease>1 year,taking anticoagulation drugs,NLR>2,hernia sac diameter>5 cm and intraoperative blood loss>10 mL were risk factors for postoperative seroma.The receiver operating characteristic(ROC)curve was drawn,which showed that the area under the curve of NLR was 0.739,and the cut-off value for predicting seroma was 1.99.Conclusion The occurrence of seroma after TAPP is related to a various factors,and preoperative NLR has a certain effect on predicting seroma.The preventive measures and treatments can be taken according to related risk factors and preoperative predictions.

关 键 词：疝 腹股沟 TAPP 血清肿 相关因素 回归分析 中性粒细胞/淋巴细胞比值 

分 类 号：R656.2[医药卫生—外科学]