无张力疝修补术后补片感染32例再手术的疗效分析  

Clinical reoperation efficacy in 32 cases of patients with postoperative mesh infection after tension-free hernia repairs

作　　者：盛伟伟 林峰[1] 武梦成 张嘉炜[1] 汪明庆 熊茂明[1] Sheng Weiwei;Lin Feng;Wu Mengcheng;Zhang Jiawei;Wang Mingqing;Xiong Maoming(Gastrointestinal and Hernia Surgery District,Department of General Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei,230022,China)

机构地区：[1]安徽医科大学第一附属医院普外科,胃肠与疝外科病区,合肥230022

出　　处：《中华疝和腹壁外科杂志（电子版）》2024年第3期311-314,共4页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

基　　金：安徽省重点研究与开发计划项目(201904a07020045);安徽省转化医学研究院科研基金(2023zhyx-C36);安徽医科大学临床科学基金项目(2023xkj140)。

摘　　要：目的分析无张力疝修补术后补片感染再手术的临床疗效。方法回顾性分析2019年10月至2023年8月安徽医科大学第一附属医院收治的32例无张力疝修补术后补片感染患者的临床资料,32例患者均在全身麻醉下行清创术,即亚甲蓝辅助染色、取出补片、冲洗伤口和负压封闭引流。分析术中情况、术后细菌培养和药敏及最终疗效。结果32例患者均成功经手术完全取出感染补片,其中单纯补片取出10例(31.3%),取出感染补片并术中重新置入补片1例,补片取出联合窦道切除或肠管部分切除21例(65.6%),包含3例同时行肠管部分切除术。感染部位细菌药敏提示:多数为以金黄色葡萄球菌为主的单一感染,对喹诺酮类及β内酰胺类抗生素较敏感。术后患者均顺利出院,随访感染复发5例,疝单纯复发2例。结论无张力疝修补术后补片感染一经发现,应早期治疗,手术治疗过程中,合理使用亚甲蓝辅助清创、完整取出补片、严格冲洗伤口、负压封闭引流和术后个体化抗生素应用是安全可靠的治疗方式。Objective To analyze the clinical reoperation efficacy of postoperative mesh infection with tension-free hernia repair surgery.Methods A retrospective analysis was conducted on the clinical data of 32 patients with postoperative mesh infection after tension-free hernia repair at the First Affiliated Hospital of Anhui Medical University from October 2019 to August 2023.All 32 patients underwent debridement under general anesthesia,including methylene blue assisted staining,mesh removal,wound flushing,and negative pressure closure drainage.Intraoperative situation,postoperative bacterial culture and drug sensitivity,and final therapeutic effect were analyzed.Results One case underwent intraoperative replacement of a mesh,while three cases underwent partial intestinal resection simultaneously.Bacterial susceptibility from infection site indicates that most cases are single infections mainly caused by Staphylococcus aureus,which are sensitive by Quinolone drugs andβ-Lactamide antibiotics.All patients were discharged from the hospital successfully.Postoperative follow-up showed 5 cases of infection recurrence and 2 cases of simple hernia recurrence.Conclusion Mesh infection after tension-free hernia repair should be treated early.During the surgical treatment,the rational use of methylene assisted debridement,complete removal of the mesh,strict flushing of the wound,negative pressure sealing drainage,and postoperative individualized antibiotic application are safe and reliable treatment methods.

关 键 词：疝 腹股沟 无张力疝修补术 补片感染 治疗 

分 类 号：R656.21[医药卫生—外科学]