腹腔镜腹股沟疝修补术后补片感染的外科治疗  

Surgical treatment of mesh infection after laparoscopic inguinal hernia repair

作　　者：邹振玉 曹金鑫[1] 朱熠林[1] 刘雨辰[1] 邢晓伟 马秋月 申英末[1] Zou Zhenyu;Cao Jinxin;Zhu Yilin;Liu Yuchen;Xing Xiaowei;Ma Qiuyue;Shen Yingmo(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：《中华消化外科杂志》2023年第9期1080-1085,共6页Chinese Journal of Digestive Surgery

基　　金：北京市自然科学基金(7234373)。

摘　　要：目的探讨腹腔镜腹股沟疝修补术后补片感染的外科治疗。方法采用回顾性描述性研究方法。收集2018年1月至2020年12月首都医科大学附属北京朝阳医院收治的32例行腹腔镜腹股沟疝修补术后补片感染患者的临床资料;男30例,女2例;年龄为59(19~81)岁。患者均行感染清创术。观察指标:(1)手术及术后情况。(2)随访情况。正态分布的计量资料以x±s表示,组间比较采用独立样本t检验;偏态分布的计量资料以M(范围)表示。计数资料以绝对数或百分比表示,组间比较采用Fisher确切概率法。结果(1)手术及术后情况。32例患者均顺利施行感染清创术,手术时间为110(45~220)min,术中出血量为24(5~200)mL。32例患者中,6例直接行开放清创手术,26例先行腹腔镜探查,其中12例发现感染原因:4例补片感染突破腹膜侵入肠管造成肠瘘,均在腹腔镜下缝合修补瘘口,3例残留大量医用胶,3例补片皱缩、卷曲,2例使用黑丝线缝合腹膜;18例完全取出感染补片、14例部分取出感染补片;18例行腹腔镜后入路取出感染补片,14例行开放前入路取出感染补片。32例患者中,29例行细菌培养和药物敏感性试验,其中24例细菌培养为阳性,5例细菌培养为阴性。32例患者住院时间为27.0(9.0~85.0)d。(2)随访情况。32例患者均获得随访,随访时间为37.9(18.7~52.5)个月。18例完全取出感染补片和14例部分取出感染补片患者术后切口感染分别为5例和2例,两者比较,差异无统计学意义(P>0.05);两者发生血清肿分别为7、4例,再发腹壁感染性窦道分别为5、6例,两者上述指标比较,差异均无统计学意义(P>0.05);均无血肿、腹股沟疝复发、慢性疼痛发生。7例切口感染患者经对症治疗后恢复良好;12例血清肿患者未予特殊治疗;10例再发腹壁感染性窦道患者均再次行清创手术后,9例未再发腹壁感染,1例行3次清创手术。结论腹腔镜腹股沟疝修补术后补片感�Objective To investigate the surgical treatment of mesh infection after lapa-roscopic inguinal hernia repair.Methods The retrospective and descriptive study was conducted.The clinical data of 32 patients with mesh infection after laparoscopic inguinal hernia repair who were admitted to the Affiliated Beijing Chaoyang Hospital of Capital Medical University from January 2018 to December 2020 were collected.There were 30 males and 2 females,aged 59(range,19-81)years.All patients underwent debridement.Observation indicators:(1)surgical and postopera-tive situations;(2)follow-up.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the independent sample t test.Measurement data with skewed distribution were represented as M(range).Count data were described as absolute numbers or percentages,and comparison between was conducted using Fisher exact probability.Results(1)Surgical and postoperative situations.All 32 patients underwent debridement success-fully,with the operation time and volume of intraoperative blood loss as 110(range,45-220)minutes and 24(range,5-200)mL.Of the 32 patients,there were 6 cases undergoing open debridement,26 cases undergoing laparoscopic exploration with 12 cases clarified the cause of infection,in which 4 cases had intestinal fistula by mesh infection breaking through the peritoneum and invading the intestinal tract and underwent laparoscopic intestinal fistula repair,3 cases had significant amount of residual medical glue,3 cases had mesh wrinkling and curling,2 cases underwent peritoneum suturing with black silk thread.There were 18 cases undergoing complete removal of infected mesh and 14 cases undergoing partial mesh removal.There were 18 cases undergoing removal of infected mesh by laparoscopic posterior approach and 14 cases undergoing removal of infected mesh by open anterior approach.Twenty-nine of the 32 patients had bacterial culture and drug allergy testing,including 24 cases with positive cultures,while 5 cases w

关 键 词：疝 腹股沟 开放 补片 感染 腹腔镜检查 

分 类 号：R656.21[医药卫生—外科学]