急诊和择期股疝临床特点及其修补后早期临床效果的回顾性队列研究

doi:10.3877/cma.j.issn.1674-392X.2022.06.013

目的

比较急诊和择期股疝的临床特点及修补术后早期临床效果。

方法

回顾性分析2013年1月至2018年12月，赣州市人民医院手术治疗的股疝患者的临床资料，其中择期股疝组53例，急诊股疝组85例。

结果

2组病例均以女性偏多，急诊组较择期组的病程偏长，年龄偏高；急诊组中有并存病的患者较多，以慢性阻塞性肺疾病、肝硬化多见。急诊组和择期组中肠梗阻患者分别为64例和4例，2组术中需肠切除、肠吻合的患者分别为14例和0例，但2组的修补方式差异无统计学意义。术后血清肿和浅表感染急诊组较择期组明显偏多，差异有统计学意义（P<0.05）。术后1个月内急诊组死亡7例，而择期组无死亡病例，K-M曲线分析Log-rank检验，差异有统计学意义（P<0.05）。

结论

急诊股疝合并症较择期股疝多，病程长，术后并发症多，且术后1个月内死亡率高。所以股疝一旦确诊，应及时纠正患者的并存病，尽早手术，或许可以改善股疝患者的预后。

关键词: 急诊处理, 择期手术, 股疝, 疝修补术, 回顾性研究, 队列研究

Objective

To compare the clinical characteristics of emergency and elective femoral hernia and the early clinical effects after repair.

Methods

The clinical data of patients with femoral hernia who treated surgically in Ganzhou People's Hospital from January 2013 to December 2018 were retrospectively analyzed, including 53 cases in the elective femoral hernia group and 85 cases in the emergency femoral hernia group.

Results

The cases in both groups were mostly female, and the course of disease in the emergency group was longer and age was higher than those in the elective group. In the emergency group, there were more patients with comorbidities, and the comorbidities were mostly COPD and cirrhosis. There were 64 cases of intestinal obstruction in the emergency group and 4 cases in the elective group, and 14 cases and no case of intestinal anastomosis was required in the two groups, respectively. However, there was no significant difference in the repair methods between the two groups. The complications of postoperative seroma and superficial infection were more frequent in the emergency group than that in the elective group, and the difference was statistically significant (P<0.05). There were 7 deaths in the emergency group and no death in the elective group within one month after surgery, the Kaplan-Meier curve analysis log-rank test showed that the difference was statistically significant (P<0.05).

Conclusion

Complications of emergency femoral hernia were more frequent than those of elective femoral hernia, the course of disease was longer, postoperative complications were more frequent, and the mortality was higher within 1 month after operation. Therefore, once the diagnosis of femoral hernia is confirmed, the patient's comorbidities should be corrected in time, and surgery should be performed as soon as possible, which might improve the prognosis of patients with femoral hernia.

Key words: Emergency treatment, Elective surgical procedures, Hernia, femoral, Herniorrhaphy, Retrospective study, Cohort study

表1 2组患者临床病例特征[例（%）]

组别	例数	女性	疝的部位		体质量指数(kg/m²,±s)	病程(月,±s)	年龄(岁,±s)	ASA分级
组别	例数	女性	左侧	右侧	体质量指数(kg/m²,±s)	病程(月,±s)	年龄(岁,±s)	Ⅰ	Ⅱ	Ⅲ	Ⅳ
择期组	53	31(58.5)	26(49.1)	27(50.9)	18.8±2.0	19.4±19.2	63.8±7.9	36(67.9)	17(32.1)	0	0
急诊组	85	54(63.5)	50(58.8)	35(41.2)	18.6±2.0	97.0±66.7	74.2±8.5	15(17.6)	37(43.5)	24(28.2)	9(10.6)
t/Z/χ²值		0.350	1.259		0.421	-4.382	-7.149	-6.578
P值		0.554^※	0.294^※		0.674^†	0.000^†	0.000^†	0.000^#
组别	例数	并存病
组别	例数	糖尿病	高血压	慢性阻塞性肺疾病	抗凝治疗	冠心病	消化性溃疡	肝硬化	恶性肿瘤
择期组	53	1(1.9)	5( 9.4)	1( 1.9)	2(3.8)	2(3.8)	2(3.8)	1( 1.9)	0
急诊组	85	6(7.1)	17(20.0)	26(30.6)	3(3.5)	7(8.2)	2(2.4)	13(15.3)	5(5.9)
t/Z/χ²值		1.814	2.720	17.088	0.006	1.006	0.234	6.437	3.235
P值		0.250^*	0.099^※	0.000^*	1.000^*	0.482^*	0.638^*	0.010^*	0.156^*

表1 2组患者临床病例特征[例（%）]

组别	例数	女性	疝的部位		体质量指数(kg/m²,±s)	病程(月,±s)	年龄(岁,±s)	ASA分级
组别	例数	女性	左侧	右侧	体质量指数(kg/m²,±s)	病程(月,±s)	年龄(岁,±s)	Ⅰ	Ⅱ	Ⅲ	Ⅳ
择期组	53	31(58.5)	26(49.1)	27(50.9)	18.8±2.0	19.4±19.2	63.8±7.9	36(67.9)	17(32.1)	0	0
急诊组	85	54(63.5)	50(58.8)	35(41.2)	18.6±2.0	97.0±66.7	74.2±8.5	15(17.6)	37(43.5)	24(28.2)	9(10.6)
t/Z/χ²值		0.350	1.259		0.421	-4.382	-7.149	-6.578
P值		0.554^※	0.294^※		0.674^†	0.000^†	0.000^†	0.000^#
组别	例数	并存病
组别	例数	糖尿病	高血压	慢性阻塞性肺疾病	抗凝治疗	冠心病	消化性溃疡	肝硬化	恶性肿瘤
择期组	53	1(1.9)	5( 9.4)	1( 1.9)	2(3.8)	2(3.8)	2(3.8)	1( 1.9)	0
急诊组	85	6(7.1)	17(20.0)	26(30.6)	3(3.5)	7(8.2)	2(2.4)	13(15.3)	5(5.9)
t/Z/χ²值		1.814	2.720	17.088	0.006	1.006	0.234	6.437	3.235
P值		0.250^*	0.099^※	0.000^*	1.000^*	0.482^*	0.638^*	0.010^*	0.156^*

表2 2组患者疝内容物及肠梗阻情况[例（%）]

组别	例数	疝内容物					肠梗阻
组别	例数	无	小肠	网膜和小肠	网膜	回盲部	无	不全性	完全性
择期组	53	10(18.9)	14(26.4)	3(5.7)	26(49.1)	0	49(92.5)	4( 7.5)	0
急诊组	85	1 ( 1.2)	63(74.1)	7(8.2)	12(14.1)	2(2.4)	21(24.7)	54(63.5)	10(11.8)
t/Z/χ²值		44.486					-8.377
P值		0.000^＊					0.000^#

表2 2组患者疝内容物及肠梗阻情况[例（%）]

组别	例数	疝内容物					肠梗阻
组别	例数	无	小肠	网膜和小肠	网膜	回盲部	无	不全性	完全性
择期组	53	10(18.9)	14(26.4)	3(5.7)	26(49.1)	0	49(92.5)	4( 7.5)	0
急诊组	85	1 ( 1.2)	63(74.1)	7(8.2)	12(14.1)	2(2.4)	21(24.7)	54(63.5)	10(11.8)
t/Z/χ²值		44.486					-8.377
P值		0.000^＊					0.000^#

表3 2组手术相关数据、并发症和随访结果

组别	例数	疝内容物处理[例（%）]			修补方式[例（%）]			手术时间(min,±s)
组别	例数	坏死小肠切除	回纳疝内容物	坏死小肠和网膜切除	开放式补片修补	腔镜下修补	缝合修补	手术时间(min,±s)
择期组	53	0	43(81.1)	0	41(77.4)	4(7.5)	23(43.4)	85.2±25.0
急诊组	85	11(12.9)	70(82.4)	3(3.5)	59(69.4)	3(3.5)	8(9.4)	109.8±28.5
t/Z/χ²值		32.71			3.485			-5.17
P值		0.000^＊			0.175^＊			0.000^†
组别	例数	出血量(ml,±s)	入住ICU[例（%）]	住院时间(d,±s)	并发症[例（%）]			随访结果[例（%）]
组别	例数	出血量(ml,±s)	入住ICU[例（%）]	住院时间(d,±s)	血清肿	深部切口感染	浅表切口感染	术后1个月内死亡	失访
择期组	53	24.6±21.5	0	6.5±1.6	3( 5.7)	0	2( 3.8)	0	1(1.9)
急诊组	85	36.8±26.6	12(14.1)	7.2±2.0	24(28.2)	0	14(16.5)	7(8.2)	1(1.2)
t/Z/χ²值		-2.937	8.195	-2.119	10.572	-	5.134	7.092
P值		0.004^†	0.003^*	0.036^†	0.001^※	-	0.023^※	0.029^＊

表3 2组手术相关数据、并发症和随访结果

组别	例数	疝内容物处理[例（%）]			修补方式[例（%）]			手术时间(min,±s)
组别	例数	坏死小肠切除	回纳疝内容物	坏死小肠和网膜切除	开放式补片修补	腔镜下修补	缝合修补	手术时间(min,±s)
择期组	53	0	43(81.1)	0	41(77.4)	4(7.5)	23(43.4)	85.2±25.0
急诊组	85	11(12.9)	70(82.4)	3(3.5)	59(69.4)	3(3.5)	8(9.4)	109.8±28.5
t/Z/χ²值		32.71			3.485			-5.17
P值		0.000^＊			0.175^＊			0.000^†
组别	例数	出血量(ml,±s)	入住ICU[例（%）]	住院时间(d,±s)	并发症[例（%）]			随访结果[例（%）]
组别	例数	出血量(ml,±s)	入住ICU[例（%）]	住院时间(d,±s)	血清肿	深部切口感染	浅表切口感染	术后1个月内死亡	失访
择期组	53	24.6±21.5	0	6.5±1.6	3( 5.7)	0	2( 3.8)	0	1(1.9)
急诊组	85	36.8±26.6	12(14.1)	7.2±2.0	24(28.2)	0	14(16.5)	7(8.2)	1(1.2)
t/Z/χ²值		-2.937	8.195	-2.119	10.572	-	5.134	7.092
P值		0.004^†	0.003^*	0.036^†	0.001^※	-	0.023^※	0.029^＊

表4 股疝患者并发症相关性分析（n=138）

并发症		疝内容物的处理	手术时间	浅表感染	血清肿	疝囊内容物
浅表感染	相关系数	-0.134	0.206^*	1.000	0.221^**	0.139
浅表感染	显著性(双尾)	0.118	0.015	0.000	0.009	0.103
血清肿	相关系数	0.127	0.226^**	0.221^**	1.000	0.039
血清肿	显著性(双尾)	0.136	0.008	0.009	0.000	0.649

表4 股疝患者并发症相关性分析（n=138）

并发症		疝内容物的处理	手术时间	浅表感染	血清肿	疝囊内容物
浅表感染	相关系数	-0.134	0.206^*	1.000	0.221^**	0.139
浅表感染	显著性(双尾)	0.118	0.015	0.000	0.009	0.103
血清肿	相关系数	0.127	0.226^**	0.221^**	1.000	0.039
血清肿	显著性(双尾)	0.136	0.008	0.009	0.000	0.649

图1 Kaplan-Meier曲线分析比较2组病例术后1个月内死亡率

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Clinical characteristics and early outcomes of emergency and elective femoral hernia repair: A retrospective cohort study

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Clinical characteristics and early outcomes of emergency and elective femoral hernia repair: A retrospective cohort study