急诊腹股沟疝的诊断与治疗分析  

Diagnosis and treatment of emergency inguinal hernia

作　　者：陈昕[1] 杨恒颖 徐露[1] 胡优[1] 秦磊[1] 毛忠琦[1] 周晓俊[1] Chen Xin;Yang Hengying;Xu Lu;Hu You;Qin Lei;Mao Zhongqi;Zhou Xiaojun(Department of General Surgery,the First Affiliated Hospital of Soochow University,Suzhou 215006,Jiangsu Province,China)

机构地区：[1]苏州大学附属第一医院普通外科,215006

出　　处：《中华消化外科杂志》2021年第7期799-804,共6页Chinese Journal of Digestive Surgery

基　　金：江苏省高等学校自然科学研究重大项目(19KJA170002)。

摘　　要：目的探讨急诊腹股沟疝的诊断与治疗。方法采用回顾性横断面研究方法。收集2015年1月至2020年5月苏州大学附属第一医院收治的236例急诊腹股沟疝病人的临床资料;男194例,女42例;年龄为(69±30)岁。病人需行常规血液生化检查,以及影像学检查判断疝内容物性状及肠梗阻情况。根据病人自身情况选择手法复位和手术治疗。观察指标:(1)治疗情况。(2)随访情况。采用门诊和电话方式进行随访,了解病人疝腹发和迟发性补片感染情况。随访时间截至2020年8月。计量资料以M(范围)或M(P25,P75)表示,组间比较采用Wilcoxon秩和检验;计数资料以绝对数表示,组间比较采用χ^(2)检验。结果(1)治疗情况:236例病人中,手法复位成功106例,行急诊手术124例,拒绝手术6例。①106例病人手法复位成功(4例经B超检查引导),手法复位时间为5 min(2 min,7 min);其中93例复位后行择期手术,斜疝89例、直疝和复合疝各2例,择期手术时机为手法复位后3 d(2 d,5 d),常规行补片修补术,手术时间为44 min(29 min,66 min),术中出血量为10 mL(5 mL,20 mL),术后首次肛门排气时间为1 d(1 d,2 d),术后住院时间为1 d(1 d,2 d)。11例病人未行择期手术。2例病人手法复位成功后出现腹痛、发热,急诊手术探查示小肠穿孔,行小肠部分切除+疝囊高位结扎术。②124例行急诊手术病人中,斜疝93例、股疝18例、闭孔疝6例、复合疝6例、直疝1例;开放手术54例,包括Bassini手术21例,Lichtenstein手术18例,McVay手术9例,疝囊高位结扎术6例;腹腔镜手术70例,包括腹腔镜下经腹膜前疝修补术57例,腹腔镜探查+组织缝合修补术10例,腹腔镜探查+疝环缝合术3例。开放手术和腹腔镜手术病人手术时间、术中出血量、术后首次肛门排气时间、术后近期并发症分别为60 min(50 min,76 min)和56 min(47 min,77 min),20 mL(14 mL,30 mL)和20 mL(10 mL,25 mL)、2 d(1 d,2 d)和2 d(1 d,2 d)、15例和21例,两者�Objective To investigate the diagnosis and treatment of emergency inguinal hernia.Methods The retrospective cross-sectional study was conducted.The clinical data of 236 patients with emergency inguinal hernia who were admitted to the First Affiliated Hospital of Soochow University from January 2015 to May 2020 were collected.There were 194 males and 42 females,aged(69±30)years.Hospitalized patients received routine blood biochemistry test and imaging examinations for evaluation of characteristics of hernia contents and intestinal obstruction.Manual reduction and surgical treatment were selected according to the conditions of patients.Observation indicators:(1)treatment;(2)follow-up.Follow-up using outpatient examination and telephone interview was performed to detect hernia recurrence and late-onset mesh infection up to August 2020.Measurement data were described as M(range)or M(P25,P75),and comparison between groups was analyzed using the Wilcoxon rank sum test.Count data were represented as absolute numbers,and comparison between groups was done using the chi-square test.Results(1)Treatment:of the 236 patients,106 cases had successful manual reduction,124 cases underwent emergency operation,6 cases refused surgery.①For 106 cases with successful manual reduction(including 4 cases guided by B-ultrasonography),the manual reduction time was 5 minutes(2 minutes,7 minutes).Ninety-three of 106 patients underwent selective operation after manual reduction,including 89 cases with indirect hernia,2 cases with direct hernia and 2 cases with compound hernia.The time to selective operation was 3 days(2 days,5 days)after manual reduction.Patients underwent mesh repair,of which the operation time,volume of intraoperative blood loss,time to postoperative first flatus,duration of postoperative hospital stay were 44 minutes(29 minutes,66 minutes),10 mL(5 mL,20 mL),1 day(1 day,2 days),1 day(1 day,2 days),respectively.Eleven patients didn't undergo selective operation.Two patients with abdominal pain and fever after manual redu

关 键 词：疝 腹股沟 急诊手术 疝修补术 经腹腹膜前疝修补术 临床疗效 

分 类 号：R656.21[医药卫生—外科学]