切换至 "中华医学电子期刊资源库"

中华疝和腹壁外科杂志(电子版) ›› 2019, Vol. 13 ›› Issue (05) : 413 -416. doi: 10.3877/cma.j.issn.1674-392X.2019.05.007

所属专题: 文献

临床论著

腹股沟疝修补术后急性感染去除补片指征的探讨
张成鹏1, 郭新宇1, 郭晓1, 李林强1, 林汉1, 陆朝阳1,()   
  1. 1. 150001 哈尔滨医科大学附属第一医院肝脏与腹壁疝外科
  • 收稿日期:2019-05-21 出版日期:2019-10-18
  • 通信作者: 陆朝阳
  • 基金资助:
    吴阶平医学基金(320.6750.16206)

Indication of mesh removal after acute infection following inguinal hernia repair

Chengpeng Zhang1, Xinyu Guo1, Xiao Guo1, Linqiang Li1, Han Lin1, Zhaoyang Lu1,()   

  1. 1. Department of Liver and Abdominal Wall Hernia Surgery, First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
  • Received:2019-05-21 Published:2019-10-18
  • Corresponding author: Zhaoyang Lu
  • About author:
    Corresponding author: Lu Zhaoyang, Email:
引用本文:

张成鹏, 郭新宇, 郭晓, 李林强, 林汉, 陆朝阳. 腹股沟疝修补术后急性感染去除补片指征的探讨[J]. 中华疝和腹壁外科杂志(电子版), 2019, 13(05): 413-416.

Chengpeng Zhang, Xinyu Guo, Xiao Guo, Linqiang Li, Han Lin, Zhaoyang Lu. Indication of mesh removal after acute infection following inguinal hernia repair[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2019, 13(05): 413-416.

目的

探讨腹股沟疝修补术后补片急性感染状态下补片去除的时机和指征。

方法

收集2016年1月至2018年10月,哈尔滨医科大学附属第一医院经治腹股沟疝修补术后补片急性感染患者12例,回顾性分析临床资料,并总结治疗经验。

结果

本组患者在术后1周至1个月确诊感染后经保守治疗3周至5个月取出感染补片,其中后期应用自制评分系统决定取出补片时机的患者4例。取出感染补片后切口愈合良好出院患者10例,2次手术取出残余补片患者1例,切口敞开患者术后持续真空负压吸引装置、术后3周突发心肌梗死死亡患者1例。随访患者11例,随访时间5个月至2.5年,随访期间手术侧腹股沟疝复发患者1例,但无感染迹象。其余患者切口恢复良好,无疝复发。

结论

腹股沟疝术后急性感染补片取出时机尚缺乏标准,本研究中自制评分系统是一个有益尝试。

Objective

To explore the timing and indication of mesh removal under acute infection after inguinal hernia repair.

Methods

From January 2016 to October 2018, twelve patients with acute infection after repair of inguinal hernia were treated in theFirst Affiliated Hospital of Harbin Medical University. The clinical results were retrospectively analyzed and the treatment experience was summarized.

Results

In this group, the patients were diagnosed of infection in 1 week to 1 month after the surgery, and the infected meshes wereremoved after conservative treatment for 3 weeks to 5 months after diagnosis. The latter 4 cases were treated withthe self-made scoring system to determine the timing of mesh removal. Of these, 10 patients discharged from hospital with good incision healing after removal of infected mesh, and one patient underwent reoperation to remove residual mesh. One patient with open incision sustained VSD after operation and died of myocardial infarction 3 weeks after operation. 11 patients were followed up for 5 months to 2.5 years. During the follow-up period, 1 case of inguinal hernia recurred, with no signs of infection. The other patients recovered well without hernia recurrence.

Conclusion

There is still a lack of standard for the timeofmesh removal of acute infection after inguinal hernia repair. The self-made scoring system in this study is a useful attempt.

表1 感染补片取出决策影响因素
[1]
Kathju S, Nistico L, Meltonkreft R, et al. Direct demonstration of bacterial biofilms on prosthetic mesh after ventral herniorrhaphy[J]. Surg Infect(Larchmt), 2015, 16(1): 45-53.
[2]
Berríos Torres SI, Umscheid CA, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017[J]. JAMA Surg, 2017, 152(8): 784-791.
[3]
Kong W, Wang J, Mao Q, et al. Early- Versus Late-Onset Prosthetic Mesh Infection: More than Time Alone[J]. Indian J Surg, 2015, 77(Suppl 3): 1154-1158.
[4]
Tolino MJ, Tripoloni DE, Ratto R, et al. Infections associated with prosthetic repairs of abdominal wall hernias: pathology, management and results[J]. Hernia, 2009, 13(6), 631-637.
[5]
Narkhede R, Shah NM, Dalal PR, et al. Postoperative Mesh Infection-Still a Concern in Laparoscopic Era[J]. Indian J Surg, 2015, 77(4): 322-326.
[6]
Gillion JF, Palot JP. Abdominal wall incisional hernias: Infected prosthesis: treatment and prevention[J]. J Visc Surg, 2012, 149(5 Suppl): e20-e31.
[7]
Birolini C, Minossi JG, Lima CF, et al. Mesh cancer: long-term mesh infection leading to squamous-cell carcinoma of the abdominal wall[J]. Hernia, 2014, 18(6): 897-901.
[8]
Akyol C, Kocaay F, Orozakunov E, et al. Outcome of the patients with chronic mesh infection following open inguinal hernia repair[J]. J Korean Surg Soc, 2013, 84(5): 287-291.
[9]
Berrevoet F, Vanlander A, Bontinck J, et al. Open preperitoneal mesh repair of inguinal hernias using a mesh with nitinol memory frame[J]. Hernia, 2013, 17(3): 365-371.
[10]
Stremitzer S, Bachleitner-Hofmann T, Gradl B, et al. Mesh graft infection following abdominal hernia repair: risk factor evaluation and strategies of mesh graft preservation. A retrospective analysis of 476 operations[J]. World J Surg, 2010, 34(7): 1702-1709.
[11]
Tolino MJ, Tripoloni DE, Ratto R, et al. Infections associated with prosthetic repairs of abdominal wall hernias: pathology, management and results[J]. Hernia, 2009, 13(6): 631-637.
[12]
Fawole AS, Chaparala RPC, Ambrose NS. Fate of the inguinal hernia following removal of infected prosthetic mesh[J]. Hernia, 2006, 10(1): 58-61.
[1] 李培杰, 乔永杰, 张浩强, 曾健康, 谭飞, 李嘉欢, 王静, 周胜虎. 细菌培养阴性的假体周围感染诊治的最新进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 827-833.
[2] 田文, 杨晓冬. 腹腔镜腹股沟疝修补术式选择及注意事项[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 595-597.
[3] 李涛, 陈纲, 李世拥. 腹腔镜下右侧腹股沟斜疝修补术(TAPP)[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 598-598.
[4] 刘跃刚, 薛振峰. 腹腔镜腹股沟疝日间手术在老年患者中的安全性分析[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 711-714.
[5] 杨瑞洲, 李国栋, 吴向阳. 腹股沟疝术后感染的治疗方法探讨[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 715-719.
[6] 徐金林, 陈征. 抗菌药物临床应用监测对腹股沟疝修补术预防用药及感染的影响[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 720-723.
[7] 于智慧, 赵建军. 后路腰方肌阻滞复合全身麻醉在腹股沟斜疝经腹腹膜前手术中的应用效果[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 734-739.
[8] 田静, 方秀春. 超声引导下横筋膜平面阻滞在儿童腹股沟疝手术的应用效果[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 740-744.
[9] 李静如, 王江玲, 吴向阳. 简易负压引流在腹股沟疝术后浅部感染中的疗效分析[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 745-749.
[10] 王红艳, 马艳丽, 郑洁灿. 手术室综合护理在腹股沟疝手术中的应用效果[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 755-758.
[11] 李达, 张大涯, 陈润祥, 张晓冬, 黄士美, 陈晨, 曾凡, 陈世锔, 白飞虎. 海南省东方市幽门螺杆菌感染现状的调查与相关危险因素分析[J]. 中华临床医师杂志(电子版), 2023, 17(08): 858-864.
[12] 卓徐鹏, 刘颖, 任菁菁. 感染性疾病与老年人低蛋白血症的相关性研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(08): 896-899.
[13] 李静静, 翟蕾, 赵海平, 郑波. 多囊肾合并囊肿的多重耐药菌感染一例并文献复习[J]. 中华临床医师杂志(电子版), 2023, 17(08): 920-923.
[14] 李琪, 黄钟莹, 袁平, 关振鹏. 基于某三级医院的ICU多重耐药菌医院感染影响因素的分析[J]. 中华临床医师杂志(电子版), 2023, 17(07): 777-782.
[15] 杨艳丽, 陈昱, 赵若辰, 杜伟, 马海娟, 许珂, 张莉芸. 系统性红斑狼疮合并血流感染的危险因素及细菌学分析[J]. 中华临床医师杂志(电子版), 2023, 17(06): 694-699.
阅读次数
全文


摘要