腹股沟疝无张力修补术后补片感染的外科治疗

doi:10.3877/cma.j.issn.1674-392X.2020.01.004

中华疝和腹壁外科杂志(电子版) ›› 2020, Vol. 14 ›› Issue (01) : 14 -17. doi: 10.3877/cma.j.issn.1674-392X.2020.01.004

所属专题：文献；

临床论著

腹股沟疝无张力修补术后补片感染的外科治疗

罗文钦¹, 杨世炜¹, 王永¹^,^†(

), 伍兵², 谢妍妍¹, 雷文章¹

^1. 610041　成都，四川大学华西医院胃肠外科
^2. 610041　成都，四川大学华西医院放射科

收稿日期:2019-05-28 出版日期:2020-02-18
通信作者: 王永
基金资助:
四川省卫生和计划生育委员会科研项目(150141); 四川省科技厅项目(2015JY0184); 吴阶平医学基金会临床科研专项资助(320.6750.16207)

Clinical effect of debridement for mesh infection after inguinal tension-free hernia repair

Wenqin Luo¹, Shiwei Yang¹, Yong Wang¹^,^†(), Bing Wu², Yanyan Xie¹, Wenzhang Lei¹

^1. Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China

Received:2019-05-28 Published:2020-02-18
Corresponding author: Yong Wang

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目的

探讨腹股沟疝无张力修补术后，补片感染的临床治疗经验。

方法

采用回顾性横断面研究方法，收集2012年5月至2018年1月四川大学华西医院收治的35例腹股沟疝无张力修补术后感染患者的临床资料。观察指标：（1）手术及术后情况包括术后并发症情况、术后住院时间、抗生素的选择和使用。（2）随访情况包括术后再感染和远期并发症情况。采用电话、门诊或住院方式对患者进行6个月的随访，了解患者术后再感染及远期并发症发生情况。随访时间截止至2018年7月。正态分布的计量资料采用±s表示。

结果

（1）手术及术后情况：35例腹股沟疝无张力修补术后感染患者均接受补片取出术，术后均使用抗生素抗感染治疗及创面敞开引流或安置引流管负压引流，其中行局麻手术患者2例，行全麻手术患者33例。35例补片取出中有3例补片侵及肠管，其中2例行肠切除吻合，1例补片侵蚀肠管为阑尾，行阑尾切除术。平均术后住院时间为（6.72±3.43）d。（2）随访情况：术后随访6个月，随访期间患者无术后并发症发生。患者术后随访均无腹股沟疝复发。

结论

对腹股沟疝无张力修补术后补片感染患者，行补片取出术安全可靠，在处理补片感染时应及时手术。

关键词: 疝, 腹股沟, 无张力疝修补术, 补片感染

Objective

To investigate the clinical effect of debridement for mesh infection after inguinal tension-free hernia repair.

Methods

The retrospective cross-sectional study was conducted.The clinical data of 35mesh infection patients after inguinal tension-free hernia repair who were admitted to West China Hospital of Sichuan University form May 2012 to January 2018 were collected. Observation indicators: (1) preoperative and surgical situations: complication, duration of hospital stay and antibiotics; (2) Follow-up situations: recurrence and long-term complications of debridement for mesh infection. Followup using telephone interview, outpatient examination and inpatient examination was performed to detect the hernia recurrence andlong-term complications for 3 months up to July 2018. Measurement data with normal distribution were represented as ±s.

Results

(1)Surgical and postoperative situations: 35 mesh infection patients underwent successful debridement. Postoperatively, all patients were treated with systemic antibiotic therapy and received indwelling plasma drainage-tube after debridement. 33 patients with general anaesthesia debridement were done. 2 patients with local anaesthesia were done. Of 35 patients, 3 intestinal perforation was found. The duration of hospital stay was (6.72±3.43) days. (2) Follow-up situation: All patients were followed up for 3 months, without recurrence and related complications of inguinal hernia.

Conclusion

Debridement for mesh removal was also a commendatory method for mesh infection. Debridement for mesh removal should be considered if no improvement after a 2-week conservative management.

Key words: Hernia, inguinal, Tension-free hernia repair, Mesh infection

图2 患者，男性，23岁，右侧腹股沟疝术后补片感染伴窦道形成，术中见窦道周围感染灶约4.0 cm×3.0 cm大小，美蓝沿窦道示踪后，清除感染组织，钝性分离并去除网塞和补片组，完整取出网片

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