腹股沟疝无张力修补术后补片感染的外科治疗策略  

Surgical treatment strategies of mesh infection after tension⁃free repair of inguinal hernia

作　　者：王帆[1] 靳翠红 申英末[1] 陈杰[1] 赵学飞[1] 袁昕 Wang Fan;Jin Cuihong;Shen Yingmo;Chen Jie;Zhao Xuefei;Yuan Xin(Department of Hernia and Abdominal Wall Surgery,Beijing Chaoyang H spital,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》2020年第10期1070-1075,共6页Chinese Journal of Digestive Surgery

基　　金：北京市卫生系统高层次卫生技术人才培养计划(2015⁃3⁃031);吴阶平医学基金会临床科研专项资助基金(320.6750.19091⁃4)。

摘　　要：目的探讨腹股沟疝无张力修补术后补片感染的外科治疗策略。方法采用回顾性描述性研究方法。收集2013年3月至2018年5月首都医科大学附属北京朝阳医院收治的88例腹股沟疝无张力修补术后补片感染患者的临床资料;男85例,女3例;平均年龄为58岁,年龄范围为14~84岁。患者均行清创手术。观察指标:(1)手术及术后情况。(2)随访情况。采用门诊或电话方式进行随访,了解患者术后伤口愈合情况,术后疝复发,术后疼痛及再感染情况。随访时间截至2019年7月。正态分布的计量资料以x􀭰±s表示,偏态分布的计量资料以M(范围)表示,计数资料以绝对数表示。结果(1)手术及术后情况:88例患者均顺利施行清创手术。88例患者中,71例行清创手术前先行腹腔镜探查,17例直接行开放清创手术。71例行腹腔镜探查患者中,63例经探查腹腔,分离肠管、网膜粘连后,未见肠管、膀胱等组织明显受感染累及,腹膜完整,遂中转行开放清创手术;4例经探查证实为小肠瘘,分离粘连后中转行开放清创手术,并行小肠部分切除吻合术;3例经探查证实为网塞感染,经腹腔镜切开腹膜自后入路取出感染网塞;1例经探查证实为膀胱瘘,经腹腔镜清除感染补片后行膀胱缝合修补术。88例患者中,82例为补片感染,其中31例完整清除补片,51例清除补片感染部分,术中发现合并线结感染28例,予以清除;6例仅为浅表感染,予以切除窦道等感染组织。84例行开放清创手术患者中,65例伤口放置引流管后行一期缝合;19例伤口敞开,视术后换药情况,13例放置负压封闭引流装置行持续引流,6例行换药治疗。88例患者手术时间为60 min(15~175 min),术中出血量为14 mL(2~200 mL),术后住院时间为22 d(1~101 d),术后均顺利拔管。88例患者术后切口愈合情况包括甲级愈合56例,乙级愈合15例,丙级愈合17例。88例患者中,71例术中留取脓液及缝线线结行细菌培Objective To investigate the surgical treatment strategies of mesh infection after tension⁃free repair of inguinal hernia.Methods The retrospective and descriptive study was conducted.The clinical data of 88 patients with mesh infection after tension⁃free inguinal hernia repair who were admitted to Beijing Chaoyang Hospital Affiliated to Capital Medical University from March 2013 to May 2018 were collected.There were 85 males and 3 females,aged from 14-84 years,with an average age of 58 years.All patients underwent debridement.Observation indicators:(1)surgical and postoperative situations;(2)follow⁃up.Follow⁃up using outpatient examination or telephone interview was conducted to detect wound healing,recurrence of inguinal hernia,postoperative pain and reinfection after operation up to July 2019.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were represented as M(range).Count data was described as absolute numbers.Results(1)Surgical and postoperative situations:88 patients underwent debridement successfully.Of the 88 patients,71 cases underwent laparoscopic exploration before undergoing debridement,and 17 cases underwent open debridement directly.Of the 71 patients who underwent laparoscopic exploration,63 cases had intact peritoneum with no infection observed in intestine and bladder after laparoscopic abdominal exploration,and then were transferred to open debridement.Four cases with small bowel fistula confirmed by laparoscopic exploration were transferred to open debridement combined with small bowel resection and anastomosis after separating tissue adhesion.Three cases with mesh infection confirmed by laparoscopic exploration underwent the treatment of opening peritoneum and removing the infection mesh through posterior approach under laparoscopy.One case with bladder fistula confirmed by laparoscopic exploration underwent bladder repair after removing infection mesh under laparoscopy.Of the 88 patients,82 cases had mesh infection

关 键 词：疝 腹股沟 无张力修补术 感染 补片 手术 

分 类 号：R656.21[医药卫生—外科学]