股疝开放式前入路修补的临床疗效

doi:10.3877/cma.j.issn.1674-392X.2018.02.013

目的

总结开放式腹膜前修补40例股疝的手术效果。

方法

回顾性分析2014年5月至2016年12月，赣州市人民医院接受手术40例股疝的临床资料，其中急诊股疝组27例，择期股疝组13例。

结果

择期组中疝囊内容物8例为网膜，4例为积液，1例为小肠；急诊组中内容物为肠管的26例，1例为单纯嵌顿网膜。13例择期组和13例急诊组患者进行了经腹膜前使用补片修补，另14例急诊组患者进行了Mcvay法组织的缝合修补；急诊组中有6例进行了肠切除肠吻合。择期组中早期并发症为3例次，急诊组为24例次，2组比较差异有统计学意义（P<0.05）；2组的平均住院时间分别为（6.615±1.321）d和（7.777±2.206）d，平均手术时间分别（77.692±22.695）min和（94.211±13.927）min，2组比较差异均有统计学意义（P均<0.05）；随访过程中26例补片修补的患者均未发生补片感染；补片修补的无复发病例，急诊组缝合修补的出现1例复发。

结论

开放式腹膜前无张力补片疝修补术是一种安全和可供选择的治疗择期股疝和部分急诊股疝的手术方式；但急诊手术的早期并发症较择期手术多，建议尽可能在择期状态下对股疝进行手术治疗。

关键词: 股疝, 疝修补术, 急诊手术, 择期手术, 并发症

Objective

To summarize the effect of open preperitoneal repair in 40 cases of femoral hernia.

Methods

A retrospective analysis was conducted on 40 cases of femoral hernia in Ganzhou People's Hospital from May 2014 to December 2016, including 27 emergency cases and 13 elective cases.

Results

In the elective group, the contents were 8 cases of omentum, 4 cases of hydrops, and 1 case of small intestine. In the emergency group, there were 26 cases of intestinal and 1 case of incarcerated omentum. 13 elective cases and 13 emergency cases received the preperitoneal mesh repair, and the other 14 emergency cases were perfomed with the suture repair following the Mcvay method. In the emergency group, 6 cases underwent intestinal excision. 3 elective cases and 24 emergency cases developed early complications, and the difference was statistically significant. The operation time was (94.211±13.927 min) and the length of stay was (7.777±2.206 d) in the emergency group, were longer than elective cases of (77.692±22.695 min) and (6.615±1.321 d), both had statistical significance; No mesh infection and no recurrence were found in mesh group in the follow-up duration, while there was one emergency case in suture group occurred.

Conclusion

Open preperitoneal mesh repair is a safe and optional procedure for the treatment of selective and some emergency femoral hernia. However, the early complication of the femoral hernia in the emergency cases was more than that in the selective cases. So we suggest that surgical treatment of femoral hernia should be performed at the time of selection as far as possible.

Key words: Femoral hernia, Herniorrhaphy, Emergency surgery, Elective surgery, complications

表1 2组患者疝内容物及其处理情况比较[例（%）]

组别	例数	单纯积液	单纯网膜	网膜和小肠	单纯小肠	结肠	损伤肠壁修补	坏死网膜切除	切除坏死小肠
择期组	13	4 (30.8)	8 (61.5)	0	1 (7.7)	0	0	0	0
急诊组	27	0	1 (3.7)	2 (7.4)	22 (81.5)	2 (7.4)	3 (11.1)	2 (7.4)	6 (22.2)
χ²/Z值	?	Z=6.736	χ²=16.832	Z=1.622	χ²=19.551	Z=4.372	Z=5.758	Z=4.372	Z=17.489
P值	?	0.009	0	0.203	0	0.037	0.016	0.037	0

表1 2组患者疝内容物及其处理情况比较[例（%）]

组别	例数	单纯积液	单纯网膜	网膜和小肠	单纯小肠	结肠	损伤肠壁修补	坏死网膜切除	切除坏死小肠
择期组	13	4 (30.8)	8 (61.5)	0	1 (7.7)	0	0	0	0
急诊组	27	0	1 (3.7)	2 (7.4)	22 (81.5)	2 (7.4)	3 (11.1)	2 (7.4)	6 (22.2)
χ²/Z值	?	Z=6.736	χ²=16.832	Z=1.622	χ²=19.551	Z=4.372	Z=5.758	Z=4.372	Z=17.489
P值	?	0.009	0	0.203	0	0.037	0.016	0.037	0

表2 2组患者围手术期及早期并发症结果比较

组别	例数	住院时间(d,±s)	手术时间(min,±s)	血肿[例(%)]	血清肿[例(%)]	膀胱损伤[例(%)]	尿潴留[例(%)]	早期伤口疼痛[例(%)]	切口感染[例(%)]
择期组	13	6.615±1.321	77.692±22.695	0	1(7.7)	0	1(7.7)	1(7.7)	0
急诊组	27	7.777±2.206	94.211±13.927	4(14.8)	4(14.8)	1(3.7)	3(11.1)	8(29.6)	4(14.8)
t/Z/χ²值	?	t=6.342	t=4.796	χ²=2.140	χ²=0.407	Z=0.494	χ²=0.114	χ²=2.422	χ²=2.140
P值	?	0	0	0.144	0.523	0.482	0.736	0.12	0.144

表2 2组患者围手术期及早期并发症结果比较

组别	例数	住院时间(d,±s)	手术时间(min,±s)	血肿[例(%)]	血清肿[例(%)]	膀胱损伤[例(%)]	尿潴留[例(%)]	早期伤口疼痛[例(%)]	切口感染[例(%)]
择期组	13	6.615±1.321	77.692±22.695	0	1(7.7)	0	1(7.7)	1(7.7)	0
急诊组	27	7.777±2.206	94.211±13.927	4(14.8)	4(14.8)	1(3.7)	3(11.1)	8(29.6)	4(14.8)
t/Z/χ²值	?	t=6.342	t=4.796	χ²=2.140	χ²=0.407	Z=0.494	χ²=0.114	χ²=2.422	χ²=2.140
P值	?	0	0	0.144	0.523	0.482	0.736	0.12	0.144

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Clinical analysis of 40 cases of open preperitoneal repair for femoral hernia

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Clinical analysis of 40 cases of open preperitoneal repair for femoral hernia