腹股沟疝修补术后出血及抗栓药物影响的临床分析

doi:10.3877/cma.j.issn.1674-392X.2020.03.004

目的

探讨腹股沟疝修补术后出血的影响因素及口服抗栓药物的影响。

方法

选取2018年1至12月，重庆医科大学附属第一医院收治的559例腹股沟疝患者，进行回顾性分析，研究患者的一般资料、手术方式、手术时机、抗栓药物使用种类与腹股沟疝补片修补术后出血并发症的关系。

结果

559例腹股沟疝手术，患者年龄、性别、手术方式、手术时机、初发或复发疝、抗栓药物的种类等对于术后出血没有明显的相关性。根据严重出血的探查结果，严重出血主要与血管损伤和处理有关。

结论

合理的停用和桥接抗栓药物，避免损伤血管的遗漏是减少腹股沟疝术后出血的重要条件。

关键词: 疝，腹股沟, 疝修补术, 术后出血, 手术方式, 抗栓药物

Objective

To investigate the influencing factors of postoperative bleeding after inguinal hernia repair and the effects of oral antithrombotic agents.

Methods

A retrospective analysis was conducted on 559 patients who received inguinal hernia repair in the First Affiliated Hospital of Chongqing Medical University from January 2018 to December 2018. The general information, surgical methods, timing of surgery, types of antithrombotic drugs used were studied and the relationship between bleeding complications was analyzed.

Results

A total of 559 inguinal hernia patients were collected. Age, gender, surgical method, timing of surgery, initial or recurrent hernia, and types of antithrombotic drugs had no significant correlation with postoperative bleeding. According to the investigation results of severe bleeding, severe bleeding was mainly related to vascular injury.

Conclusion

Reasonable deactivation and bridging of antithrombotic drugs and avoid omission of injured blood vessels are important condition for reducing postoperative bleeding in inguinal hernia repair.

Key words: Hernia, inguinal, Herniorrhaphy, Postoperative bleeding, Surgical method, Antithrombotic drugs

表1 患者出血与临床特点的关系

?		年龄(岁,±s)	性别[例(%)]		手术部位[例(%)]		手术方式[例(%)]		手术次数[例(%)]
?		年龄(岁,±s)	男性	女性	单侧	双侧	腹腔镜	开放	初发疝	复发疝
未出血组	(239例)	63.52±15.77	399(78.7)	40(76.9)	303(77.9)	136(80)	119(83.8)	320(76.7)	432(78.8)	7(63.6)
出血组	(120例)	62.53±15.80	108(21.3)	12(23.1)	86(22.1)	34(20.0)	23(16.2)	97(23.3)	116(21.2)	4(36.4)
统计值	?	1.005	0.088	?	0.312	?	3.136	?	1.477	?
P值	?	0.476 0	0.767	?	0.577	?	0.077	?	0.224	?
?			抗栓药[例(%)]		手术时机[例(%)]		抗栓药物[例(%)]				住院时间(d,±s)
?			无药	有药	择期	急诊	ASA	RX	AT-X	WF	住院时间(d,±s)
未出血组	(239例)		394(80.9)	48(69.6)	420(78.5)	19(79.2)	26(70.3)	12(52.2)	3(75)	4(80)	7.42±4.75
出血组	(120例)		93(19.1)	21(30.4)	115(21.5)	5(20.8)	11(29.7)	11(47.8)	1(25)	1(20)	7.66±3.85
统计值		?	4.297	?	0.006	?	2.792	?	?	?	1.523
P值		?	0.038	?	1.000	?	0.425	?	?	?	0.003

表1 患者出血与临床特点的关系

?		年龄(岁,±s)	性别[例(%)]		手术部位[例(%)]		手术方式[例(%)]		手术次数[例(%)]
?		年龄(岁,±s)	男性	女性	单侧	双侧	腹腔镜	开放	初发疝	复发疝
未出血组	(239例)	63.52±15.77	399(78.7)	40(76.9)	303(77.9)	136(80)	119(83.8)	320(76.7)	432(78.8)	7(63.6)
出血组	(120例)	62.53±15.80	108(21.3)	12(23.1)	86(22.1)	34(20.0)	23(16.2)	97(23.3)	116(21.2)	4(36.4)
统计值	?	1.005	0.088	?	0.312	?	3.136	?	1.477	?
P值	?	0.476 0	0.767	?	0.577	?	0.077	?	0.224	?
?			抗栓药[例(%)]		手术时机[例(%)]		抗栓药物[例(%)]				住院时间(d,±s)
?			无药	有药	择期	急诊	ASA	RX	AT-X	WF	住院时间(d,±s)
未出血组	(239例)		394(80.9)	48(69.6)	420(78.5)	19(79.2)	26(70.3)	12(52.2)	3(75)	4(80)	7.42±4.75
出血组	(120例)		93(19.1)	21(30.4)	115(21.5)	5(20.8)	11(29.7)	11(47.8)	1(25)	1(20)	7.66±3.85
统计值		?	4.297	?	0.006	?	2.792	?	?	?	1.523
P值		?	0.038	?	1.000	?	0.425	?	?	?	0.003

[1]	Fitzgibbons RJ Jr, Giobbie-Hurder A, Gibbs JO, et al. Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial[J]. JAMA, 2006, 295(3): 285-292.
[2]	Smoot RL, Oderich GS, Taner CB, et al. Postoperative hematoma following inguinal herniorrhaphy: patient characteristics leading to increased risk[J]. Hernia, 2008, 12(3): 261-265.
[3]	Zeb MH, Pandian TK, El Khatib MM, et al. Risk factors for postoperative hematoma after inguinal hernia repair: an update[J]. J Surg Res, 2016, 205(1): 33-37.
[4]	Paajanen H, Scheinin T, Vironen J. Commentary: Nationwide analysis of complications related to inguinal hernia surgery in Finland: a 5 year register study of 55, 000 operations[J]. Am J Surg, 2010, 199(6): 746-751.
[5]	Essebag V, Proietti R, Birnie DH, et al. Short-term dabigatran interruption before cardiac rhythm device implantation: multi-centre experience from the RE-LY trial[J]. Europace, 2017 19(10): 1630-1636.
[6]	Gallego P, Apostolakis S, Lip GY. Bridging evidence-based practice and practice-based evidence in periprocedural anticoagulation[J]. Circulation, 2012, 126(13): 1573-1576.
[7]	Cho SJ, Choi IJ, Kim CG, et al. Aspirin use and bleeding risk after endoscopic submucosal dissection in patients with gastric neoplasms[J]. Endoscopy, 2012, 44(2): 114-121.
[8]	Igarashi K, Takizawa K, Kakushima N, et al. Should antithrombotic therapy be stopped in patients undergoing gastric endoscopic submucosal dissection[J]. Surg Endosc, 2017, 31(4): 1-8.
[9]	Kockerling F, Roessing C, Adolf D, et al. Has endoscopic(TEP, TAPP) or open inguinal hernia repair a higher risk of bleeding in patients with coagulopathy or antithrombotic therapy? Data from the Herniamed Registry[J]. Surg Endosc, 2016, 30(5): 2073-2081.
[10]	Sanders DL, Shahid MK, Ahlijah B, et al. Inguinal hernia repair in the anticoagulated patient: a retrospective analysis[J]. Hernia, 2008, 12(6): 589-592.
[11]	Wakasugi M, Akamatsu H, Yoshidome K, et al. Totally extraperitoneal inguinal hernia repair in patients on antithrombotic therapy: a retrospective analysis[J]. Surg Today, 2013, 43(8): 942-945.
[12]	黄永刚，叶静，张方捷，吴浩，高国栋，王平. 腹股沟疝修补术后腹膜前间隙出血危险因素分析及急诊处理[J/CD]. 中华危重症医学杂志(电子版), 2017(10) 5: 328-333.
[13]	Abi-Haidar Y, Sanchez V, Itani KM. Risk factors and outcomes of acute versus elective groin hernia surgery[J]. J Am Coll Surg, 2011, 213(3): 363-369.

[1]	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.
[2]	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.
[3]	陈航, 闵翔. 日间甲状腺切除术后出血的12例临床分析及应对措施[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 600-602.
[4]	孟飞龙, 华帅, 张莹, 路广海. 经脐单孔腹腔镜后鞘后入路在全腹膜外腹股沟疝修补术中的应用[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 658-660.
[5]	王可, 范彬, 李多富, 刘奎. 两种疝囊残端处理方法在经腹腹膜前腹股沟疝修补术中的疗效比较[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 692-696.
[6]	袁伟, 张修稳, 潘宏波, 章军, 王虎, 黄敏. 平片式与填充式腹股沟疝修补术的疗效比较[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 697-701.
[7]	夏松, 姚嗣会, 汪勇刚. 经腹腹膜前与疝环充填式疝修补术治疗腹股沟疝的对照研究[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 702-705.
[8]	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.
[9]	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.
[10]	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.
[11]	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.
[12]	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.
[13]	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.
[14]	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.
[15]	代格格, 杨丽, 胡媛媛, 周文婷. 手术室综合干预在老年腹股沟疝患者中的应用效果[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 759-763.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Clinical analysis of the effects of antithrombotic drugs on postoperative bleeding after inguinal hernia repair

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Clinical analysis of the effects of antithrombotic drugs on postoperative bleeding after inguinal hernia repair