腹腔镜经腹腹膜前疝修补术后皮下积液的危险因素分析

doi:10.3877/cma.j.issn.1674-392X.2020.05.008

目的

探讨腹腔镜经腹腹膜前疝修补术（TAPP）后皮下积液的发生率及高危因素分析。

方法

回顾性分析2017年2月至2018年2月江苏省淮安市肿瘤医院TAPP治疗的82例原发性单侧腹股沟疝患者的临床资料，应用单因素及Logistic多因素分析患者术后皮下积液发生率的相关高危因素。

结果

单因素分析表明显示网片固定方式、腹股沟疝缺损大小及腹股沟疝类型对术后皮下积液的发生率有着非常显著的影响（P<0.05），而性别、年龄、体质量指数、ASA评分及是否合并内科疾病不相关（P>0.05）。多因素分析显示缺损大小分级越高及未固定网片均是皮下积液发生的独立危险因素。

结论

TAPP治疗腹股沟疝术后皮下积液的发生率与网片固定方式及腹股沟疝缺损大小相关。

关键词: 疝, 腹股沟, 腹腔镜, 疝修补术, 皮下积液, 并发症, 网片固定

Objective

To investigate the incidence and risk factors of subcutaneous seroma after transabdominal preperitoneal hernia repair (TAPP).

Methods

We retrospectively analyzed the clinical data of 82 patients with primary unilateral inguinal hernia undergoing TAPP treatment in Jiangsu Huai'an City Tumor hospital from February 2017 to February 2018. Logistic univariate analysis and multivariate analysis were used to analyze the incidence and related risk factors of subcutaneous seroma.

Results

Univariate analysis showed that mesh fixation, size of hernia defect and inguinal hernia type had a significant effect on the incidence of postoperative subcutaneous seroma (P<0.05). While gender, age, body mass index, ASA score and comorbidity were not related (P>0.05). Multivariate analysis showed that the hernia defect size and non-fixation were independent risk factors for the occurrence of postoperative subcutaneous seroma.

Conclusion

The incidence of subcutaneous seroma after TAPP in the treatment of inguinal hernia was related to mesh fixation method and inguinal hernia defect size.

Key words: Hernia, inguinal, Laparoscopes, Herniorrhaphy, Subcutaneous seroma, Complications, Mesh fixation

表1 腹股沟疝患者腹腔镜下经腹腹膜前疝修补术后发生皮下积液的单因素分析

因素		皮下积液组(8例)	对照组(74例)
年龄(岁, ±s)		63.9±3.6	63.0±7.3
性别(例)
	男性	5	47
	女性	3	27
高血压(例)
	有	2	15
	无	6	59
糖尿病(例)
	有	1	10
	无	7	64
冠心病(例)
	有	1	12
	无	7	62
欧洲疝学会分类(例)
	复合疝	1	32*
	斜疝	1	20
	直疝	6	22
ASA分级(例)
	Ⅰ/Ⅱ	5	44
	Ⅲ/Ⅳ	3	30
缺损大小分级(例)
	Ⅰ(<1.5 cm)	1	22*
	Ⅱ(1.5~3 cm)	2	25
	Ⅲ(>3 cm)	5	27
体质量指数(kg/m², ±s)		25.3±3.2	24.9±4.6
网片固定方式(例)
	未固定	2	5*
	胶水或钉合器	6	69

表1 腹股沟疝患者腹腔镜下经腹腹膜前疝修补术后发生皮下积液的单因素分析

因素		皮下积液组(8例)	对照组(74例)
年龄(岁, ±s)		63.9±3.6	63.0±7.3
性别(例)
	男性	5	47
	女性	3	27
高血压(例)
	有	2	15
	无	6	59
糖尿病(例)
	有	1	10
	无	7	64
冠心病(例)
	有	1	12
	无	7	62
欧洲疝学会分类(例)
	复合疝	1	32*
	斜疝	1	20
	直疝	6	22
ASA分级(例)
	Ⅰ/Ⅱ	5	44
	Ⅲ/Ⅳ	3	30
缺损大小分级(例)
	Ⅰ(<1.5 cm)	1	22*
	Ⅱ(1.5~3 cm)	2	25
	Ⅲ(>3 cm)	5	27
体质量指数(kg/m², ±s)		25.3±3.2	24.9±4.6
网片固定方式(例)
	未固定	2	5*
	胶水或钉合器	6	69

表2 腹股沟疝患者腹腔镜下经腹腹膜前疝修补术后发生皮下积液的多因素分析

危险因素	B	SE	Wals χ²	P值	OR	95% CI
缺损大小分级	0.326	0.079	8.636	0.016	2.969	1.944-8.651
网片固定方式	1.026	0.016	16.811	0.002	3.210	2.995-11.124
EHS分类	0.356	0.034	5.108	0.054	1.753	0.873-4.464

表2 腹股沟疝患者腹腔镜下经腹腹膜前疝修补术后发生皮下积液的多因素分析

危险因素	B	SE	Wals χ²	P值	OR	95% CI
缺损大小分级	0.326	0.079	8.636	0.016	2.969	1.944-8.651
网片固定方式	1.026	0.016	16.811	0.002	3.210	2.995-11.124
EHS分类	0.356	0.034	5.108	0.054	1.753	0.873-4.464

[1]	周义生，丁焱，朱承新, 等. 杭州市萧山区成人腹股沟疝流行病学调查及对策[J/OL]. 中华疝和腹壁外科杂志(电子版), 2016, 10(5): 385-386.
[2]	汤阳阳，黄世锋，谢德智, 等. 腹腔镜经腹腹膜前疝修补术与腹腔镜完全腹膜外疝修补术的对比研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2019, 13(1): 72-75.
[3]	刘嘉欣，李汝红，于海东, 等. TAPP与TEP对腹股沟疝术后慢性疼痛的影响[J/OL]. 中华腔镜外科杂志(电子版), 2016, 9(2): 121-123.
[4]	Nishihara Y, Isobe Y, Kitagawa Y. Validation of newly developed physical laparoscopy simulator in transabdominal preperitoneal (TAPP) inguinal hernia repair[J]. Surg Endosc, 2017, 31(12): 1-7.
[5]	Scheuermann U, Niebisch S, Lyros O, et al. Transabdominal Preperitoneal(TAPP) versus Lichtenstein operation for primary inguinal hernia repair-A systematic review and meta-analysis of randomized controlled trials[J]. Bmc Surgery, 2017, 17(1): 55.
[6]	Dong Z, Kujawa SA, Wang C, et al. Does the use of hernia mesh in surgical inguinal hernia repairs cause male infertility? A systematic review and descriptive analysis[J]. Reproductive Health, 2018, 15(1): 69.
[7]	Egawa N, Nakamura J, Manabe T, et al. Incidence of postoperative complications in transabdominal preperitoneal repair for groin hernia is influenced by poor performance status rather than by old age[J]. Null, 2019, 3(3): 318-324.
[8]	Aiolfi A, Cavalli M, Micheletto G, et al. Primary inguinal hernia: systematic review and Bayesian network meta-analysis comparing open, laparoscopic transabdominal preperitoneal, totally extraperitoneal, and robotic preperitoneal repair[J]. Hernia, 2019, 23(3): 473-484.
[9]	Yang B, Zhou S, Li Y, et al. A Comparison of Outcomes between Lichtenstein and Laparoscopic Transabdominal Preperitoneal Hernioplasty for Recurrent Inguinal Hernia[J]. Am Surg, 2018, 84(11): 1774-1780.
[10]	Sarakatsianou C, Georgopoulou S, Tzovaras G, et al. Hemodynamic effects of anesthesia type in patients undergoing laparoscopic transabdominal preperitoneal inguinal hernia repair under spinal vs general anesthesia[J]. Hernia, 2019, 23(2): 287-298.
[11]	Liu YB, Yu CC, Wu CC, et al. Feasibility and safety of elective laparoscopic total extraperitoneal preperitoneal groin hernia repair in the elderly: a propensity score-matched comparison[J]. Clin Intervent Aging, 2018, 13: 195-200.
[12]	Lin H, Zhuang Z, Ma T, et al. A meta-analysis of randomized control trials assessing mesh fixation with glue versus suture in Lichtenstein inguinal hernia repair[J]. Medicine, 2018, 97(14): e0227.
[13]	Huang DY, Pan L, Chen MY. Laparoscopic repair the transabdominal preperitoneal procedure for bilateral lumbar hernia: Three cases report and review of literature[J]. World J Clin Cases, 2018, 6(10): 398-405.
[14]	Ohuchi M, Fukunaga M, Nagakari K, et al. Surgical technique and outcomes of transabdominal preperitoneal inguinal hernia repair after radical prostatectomy: dissection between the transversalis fascia and superficial layers of preperitoneal fascia[J]. Hernia, 2019, 23(1): 167-174.
[15]	Kryspin Mitura, Karolina Garnysz, Dorota Wyrzykowska, et al. The change in groin pain perception after transabdominal preperitoneal inguinal hernia repair with glue fixation: a prospective trial of a single surgeon's experience[J]. Surg Endosc, 2018, 32(4): 4284-4289.
[16]	Köckerling F. Evidence-based TEP technique[J]. Der Chirurg, 2017, 88(4): 288-295.

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摘要

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Risk factors analysis of subcutaneous seroma following transabdominal preperitoneal hernia repair

模态框（Modal）标题

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Risk factors analysis of subcutaneous seroma following transabdominal preperitoneal hernia repair