腹腔镜腹股沟疝修补术后出血原因分析及处理  

Analysis and management of postoperative hemorrhage following laparoscopic inguinal hernia repair

作　　者：周正阳 陈凯 仇多良 邵乐宁 吴浩荣[1] 钟丰云[1] Zhou Zhengyang;Chen Kai;Qiu Duoliang;Shao Lening;Wu Haorong;Zhong Fengyun(Department of General Surgery,the Second Afiliated Hospital of Soochow University,Soochow 215004,Jiangsu Province,China)

机构地区：[1]苏州大学附属第二医院普外科,江苏215004

出　　处：《中华疝和腹壁外科杂志(电子版)》2024年第6期660-664,共5页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

基　　金：苏州市临床重点病种诊疗技术专项项目(LCZX202204)。

摘　　要：目的分析探讨导致腹腔镜下腹股沟疝修补术后出血的相关因素。方法选取2019年9月1日至2024年8月31日,于苏州大学附属第二医院进行腹腔镜腹股沟疝修补术(LIHR)的2010例患者的临床资料,进行回顾性分析。对患者的一般资料、手术方式、手术部位、手术时机、糖尿病史、术前使用抗凝药物、疝囊大小、前列腺癌根治手术史及LIHR术后复发疝等因素与术后出血发生的相关性进行分析,采用卡方检验进行单因素分析筛选可能相关的危险因素,并通过二元Logistic回归分析进一步评估其是否为独立危险因素,计算比值比(OR)及95%置信区间(CI)。结果在2010例接受LIHR的患者中,共有32例(1.59%)术后出血,其中29例经保守治疗成功止血,3例因大出血接受二次腹腔镜手术,术中发现出血原因包括巨大疝疝囊血管活动性出血、死亡冠血管出血及精索血管出血。单因素分析显示,术前使用抗凝药物、疝囊大小(≥5 cm)、前列腺癌根治手术史及LIHR术后复发疝均与术后出血显著相关(P<0.05)。进一步Logistic回归分析证实,这些因素均为术后出血的独立危险因素,其OR值分别为4.289(95%CI 1.882~9.775,P<0.001)、2.840(95%CI 1.375~5.866,P=0.005)、4.071(95%CI 1.644~10.078,P=0.002)及9.639(95%CI 4.000~23.230,P<0.001)。结论术前使用抗凝药物、疝囊≥5 cm、前列腺癌根治手术史及LIHR术后复发疝是术后出血的独立危险因素。术中血管意外损伤及处理不当亦是导致术后出血的重要原因。临床应针对上述危险因素采取预防性措施,规范术中操作,以降低术后出血的发生风险。Objective To investigate and analyze the factors associated with postoperative hemorrhage following laparoscopic inguinal hernia repair(LIHR).Methods A retrospective analysis was conducted on the clinical data of 2010 patients who underwent LIHR at the Second Affiliated Hospital of Soochow University from September 1,2019 to August 31,2024.Factors including patients&apos;general characteristics,surgical method,surgical site,timing of surgery,history of diabetes,preoperative use of anticoagulants,hernia sac size,history of radical prostatectomy,and recurrent hernia after LIHR were analyzed for their association with postoperative hemorrhage.Chi-square tests were used for univariate analysis to identify potential risk factors,followed by binary logistic regression to evaluate independent risk factors.Odds ratios(OR)and 95%confidence intervals(CI)were calculated.Results Among the 2010 patients who underwent LIHR,32 cases(1.59%)experienced postoperative hemorrhage.Of these,29 were successfully treated with conservative methods,while 3 cases required secondary laparoscopic surgery due to massive bleeding.The intraoperative causes of bleeding included active vascular bleeding from the hernia sac in large hernias,corona mortis vascular injury,and spermatic vessel bleeding.Univariate analysis showed that preoperative use of anticoagulants,hernia sac size(≥5 cm),history of radical prostatectomy,and recurrent hernia after LIHR were significantly associated with postoperative hemorrhage(P<0.05).Logistic regression confirmed these as independent risk factors,with ORs of 4.289(95%CI 1.882-9.775,P<0.001),2.840(95%CI 1.375-5.866,P=0.005),4.071(95%CI 1.644-10.078,P=0.002),and 9.639(95%CI 4.000-23.230,P<0.001),respectively.Conclusion Preoperative use of anticoagulants,hernia sac size≥5 cm,history of radical prostatectomy,and recurrent hernia after LIHR were independent risk factors for postoperative hemorrhage.Intraoperative vascular injury and improper handling were also important causes of postoperative bleeding.Clinical st

关 键 词：疝 腹股沟 腹腔镜 疝修补术 术后出血 血管损伤 

分 类 号：R73[医药卫生—肿瘤]