腹股沟疝无张力修补术后补片感染的处理  

Management of mesh infection after tension-free repair of inguinal hernia

作　　者：邹振玉 曹金鑫[1] 朱熠林[1] 申英末[1] 陈杰[1] Zou Zhenyu;Cao Jinxin;Zhu Yilin;Shen Yingmo;Chen Jie(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,北京100043

出　　处：《中华普通外科杂志》2023年第3期198-201,共4页Chinese Journal of General Surgery

基　　金：吴阶平医学基金会临床科研专项资助基金(320.6750.2021-04-35);北京市石景山区医学重点学科科研项目(2018-科-279)。

摘　　要：目的探讨腹股沟疝无张力修补术后补片感染的特点和外科处理方法。方法回顾性分析2018至2020年北京朝阳医院疝和腹壁外科收治的87例腹股沟疝无张力修补术后补片感染患者的临床和随访资料。结果患者多为网塞术后感染(57.5%),主要表现为腹壁窦道,病程超过3个月的慢性感染占79.3%,以金黄色葡萄球菌感染最常见。87例患者均顺利施行开放清创手术,51例完全取出补片,36例取出感染部分补片。随访18.7~54.2个月。补片完全取出组与部分取出组在切口感染、血清肿、血肿、腹股沟疝复发、慢性疼痛发生率方面的差异无统计学意义(均P>0.05);补片部分取出组再发腹壁窦道17例,发生率高于补片完全取出组(P<0.001)。结论取出感染补片是腹股沟疝无张力修补术后补片感染的有效治疗手段,应尽可能完全取出。Objective To investigate the characteristics and surgical management of mesh infection after tension-free repair of inguinal hernia.Methods The clinical and follow-up data of 87 patients with mesh infection after tension-free repair of inguinal hernia at the Department of Hernia and Abdominal Wall Surgery,Beijing Chaoyang Hospital from 2018 to 2020 were retrospectively analyzed.Results The most frequent type of repair was plug implantation,accounting for 57.5%of the procedures.The most common clinical presentation was a chronic sinus.79.3%patients had a>3-month history of chronic infection.Staphylococcus aureus was the most common bacteria.All patients underwent open debridement.Fifty-one patients had a complete removal of the infected mesh,and 36 had partial removal.All patients were followed up for 18.7-54.2 months.There was no significant difference in the incidence of wound infection,seroma,hematoma,inguinal hernia recurrence,and chronic pain between those with complete removal and that partial removal(all P>0.05).Seventeen cases suffered recurrent sinus in the partial mesh removal group,and the incidence was significantly higher than that in the complete mesh removal group(P<0.001).Conclusion Infected mesh removal is an effective treatment for mesh infection after tension-free repair of inguinal hernia and should be removed as completely as possible.

关 键 词：疝 腹股沟疝 细菌感染 补片 

分 类 号：R656.21[医药卫生—外科学]