嵌顿性腹股沟疝行腹腔镜经腹腹膜前疝修补术中转开腹的危险因素分析

doi:10.3877/cma.j.issn.1674-392X.2026.01.014

目的

探讨嵌顿性腹股沟疝患者行腹腔镜经腹腹膜前疝修补术（TAPP）的中转开腹情况及相关危险因素。

方法

选择2020年1月至2024年12月在广州市花都区人民医院疝和腹壁外科住院治疗的101例嵌顿性腹股沟疝患者（其中完全行TAPP术患者79例，腹腔镜中转开腹患者22例），结合2组间临床数据，来探讨行TAPP术治疗嵌顿性腹股沟疝的中转开腹情况，采用单因素和多因素分析影响中转开腹的相关危险因素，并以此制定预测模型。

结果

嵌顿性腹股沟疝行TAPP中转开腹的发生与性别、吸烟史、腹股沟疝的发病时间、疝环直径、腹腔积液、C反应蛋白、肠梗阻、疝的大小等存在相关性。且二元多因素logistical回归分析中可见C反应蛋白（OR=1.43，95% CI 1.18~1.72）、腹腔积液（OR=1.24，95% CI 1.01~3.18）是嵌顿性腹股沟疝行TAPP中转开腹的独立危险因素，根据危险因素制定的预测模型，经500次模型验证，与实际观测结果存在良好的一致性，具有统计学价值。

结论

嵌顿性腹股沟疝中转开腹与性别、吸烟史、腹股沟疝的发病时间、疝环直径、腹腔积液、C反应蛋白、肠梗阻、疝的大小等存在相关性。嵌顿性腹股沟疝宜尽早手术治疗，当患者C反应蛋白升高>11.85 mg/L或出现腹腔积液时，应提前做好开腹准备。

关键词: 嵌顿性腹股沟疝, 疝修补术, 腹腔镜, 中转开腹, 因素分析

Objective

To investigate the conversion to open surgery and related risk factors in patients with incarcerated inguinal hernia undergoing laparoscopic trans-abdominal preperitoneal hernia repair (TAPP) hernioplasty.

Methods

A total of 101 patients with incarcerated inguinal hernia who were hospitalized in the Department of Hernia and Abdominal Wall Surgery, Huadu District People's Hospital of Guangzhou from January 1, 2020 to December 30, 2024 were selected. Among them, 79 patients underwent complete TAPP surgery and 22 patients were in the laparoscopic conversion to open surgery group. Clinical data of the two groups were analyzed to explore the status of conversion to open surgery in TAPP for incarcerated inguinal hernia. Univariate and multivariate analyses were used to identify relevant risk factors for conversion to open surgery, and a predictive model was established accordingly.

Results

The conversion to open surgery in TAPP for incarcerated inguinal hernia was correlated with gender, smoking history, onset time of hernia, hernia ring diameter, peritoneal effusion, C-reactive protein (CRP), intestinal obstruction, and hernia size. Binary multivariate logistic regression analysis revealed that CRP (OR=1.43, 95% CI 1.18-1.72) and peritoneal effusion (OR=1.24, 95% CI 1.01-3.18) were independent risk factors for conversion to open surgery in patients with incarcerated inguinal hernia undergoing TAPP. The predictive model established based on these risk factors showed good consistency with actual observation results after 500 model validations, indicating statistical significance.

Conclusion

Conversion to open surgery in incarcerated inguinal hernia is correlated with gender, smoking history, onset time of hernia, hernia ring diameter, peritoneal effusion, CRP, intestinal obstruction, and hernia size. Early surgical treatment is recommended for incarcerated inguinal hernia. When a patient's CRP level exceeds 11.85 mg/L, or when peritoneal effusion is present, preparations for open surgery should be made in advance.

Key words: Incarcerated inguinal hernia, Herniorrhaphy, Laparoscopes, Conversion to laparotomy, Factor analysis

表1 TAPP治疗嵌顿性腹股沟疝中转开腹单因素分析

指标	总计(101例)	完全TAPP组(79例)	TAPP中转开腹组(22例)	t/U/χ²值	P值
年龄[年,M(Q₁,Q₃)]	65.00(50.00,77.00)	64.00(51.00,74.50)	67.50(45.75,83.50)	0.417	0.518
性别[例(%)]				6.403	0.011
女性	16(15.84)	9(10.13)	7(31.82)
男性	85(84.15)	70(89.87)	15(68.18)
吸烟史[例(%)]				8.068	0.005
无	51(50.50)	34(43.04)	17(77.27)
有	50(49.50)	45(56.96)	5(22.73)
高血压[例(%)]				<0.001	0.976
无	64(63.37)	50(63.29)	14(63.64)
有	37(36.63)	29(36.71)	8(36.36)
糖尿病[例(%)]				2.752	0.097
无	92(91.09)	70(88.61)	22(100.00)
有	9(8.91)	9(11.39)	0(0.00)
心肺疾病[例(%)]				0.493	0.482
无	82(81.19)	63 (79.75)	19(86.36)
有	19(18.81)	16 (20.25)	3(13.64)
脑血管疾病[例(%)]				0.218	0.64
无	90(89.11)	71(89.87)	19(86.36)
有	11(10.89)	8(10.13)	3(13.64)
下腹部手术史[例(%)]				0.247	0.619
无	86(85.15)	68(86.08)	18(81.82)
有	15(14.85)	11(13.92)	4(18.18)
BMI(kg/m²,x±s)	22.15±3.01	22.17±3.02	22.06±3.05	0.023	0.879
患病时间[个月,M(Q₁,Q₃)]	36.00(1.00,96.00)	48.00(5.50,108.00)	0.46(0.10,51.00)	7.686	0.006
嵌顿时间[h,M(Q₁,Q₃)]	20.00(6.00,48.00)	18.00(6.00,24.00)	36.00(9.00,66.00)	2.521	0.112
疝环直径[cm,M(Q₁,Q₃)]	3.00(2.00,3.00)	3.00(3.00,3.00)	2.00(1.50,3.00)	6.427	0.011
腹腔积液[ml,M(Q₁,Q₃)]	1.00(1.00,150.00)	1.00(1.00,125.00)	100.00(1.00,287.50)	6.459	0.011
白细胞计数[M(Q₁,Q₃)]	9.20(7.00,11.37)	9.09(6.91,10.99)	10.00(7.96,13.17)	1.493	0.222
CRP[mg/L,M(Q₁,Q₃)]	1.58(0.10,11.66)	0.95(0.10,4.53)	29.24(6.79,39.39)	21.782	<0.001
肠梗阻[例(%)]				14.769	<0.001
无	63(62.38)	57(72.15)	6(27.27)
有	38(37.62)	22(27.85)	16(72.73)
疝的大小[例(%)]				30.160	<0.001
[0,5) cm	18(17.82)	10(12.66)	8(36.36)
[5,10) cm	56(55.45)	49(62.03)	7(31.82)
[10,15) cm	17(16.83)	17(21.52)	0(0.00)
[15,20) cm	6(5.94)	3(3.80)	3(13.64)
[20,25) cm	4(3.96)	0(0.00)	4(18.18)
疝囊有无压痛[例(%)]				0.640	0.800
有	80(79.2)	63(79.7)	17(77.3)
无	21(20.8)	16(20.3)	5(22.7)
疝的类型[例(%)]				4.363	0.113
斜疝	72(71.29)	58(73.42)	14(63.64)
直疝	11(10.89)	10(12.66)	1(4.55)
股疝	18(17.82)	11(13.92)	7(31.82)
还纳方式				101	0.413
术前还纳	38(37.62)	38(48.10)	0(0.00)
术中腔镜还纳	41(40.59)	41(51.90)	0(0.00)
中转开腹	9(8.91)	0(0.00)	9(40.91)
切除坏死肠管	13(12.87)	0(0.00)	13(59.09)

表1 TAPP治疗嵌顿性腹股沟疝中转开腹单因素分析

指标	总计(101例)	完全TAPP组(79例)	TAPP中转开腹组(22例)	t/U/χ²值	P值
年龄[年,M(Q₁,Q₃)]	65.00(50.00,77.00)	64.00(51.00,74.50)	67.50(45.75,83.50)	0.417	0.518
性别[例(%)]				6.403	0.011
女性	16(15.84)	9(10.13)	7(31.82)
男性	85(84.15)	70(89.87)	15(68.18)
吸烟史[例(%)]				8.068	0.005
无	51(50.50)	34(43.04)	17(77.27)
有	50(49.50)	45(56.96)	5(22.73)
高血压[例(%)]				<0.001	0.976
无	64(63.37)	50(63.29)	14(63.64)
有	37(36.63)	29(36.71)	8(36.36)
糖尿病[例(%)]				2.752	0.097
无	92(91.09)	70(88.61)	22(100.00)
有	9(8.91)	9(11.39)	0(0.00)
心肺疾病[例(%)]				0.493	0.482
无	82(81.19)	63 (79.75)	19(86.36)
有	19(18.81)	16 (20.25)	3(13.64)
脑血管疾病[例(%)]				0.218	0.64
无	90(89.11)	71(89.87)	19(86.36)
有	11(10.89)	8(10.13)	3(13.64)
下腹部手术史[例(%)]				0.247	0.619
无	86(85.15)	68(86.08)	18(81.82)
有	15(14.85)	11(13.92)	4(18.18)
BMI(kg/m²,x±s)	22.15±3.01	22.17±3.02	22.06±3.05	0.023	0.879
患病时间[个月,M(Q₁,Q₃)]	36.00(1.00,96.00)	48.00(5.50,108.00)	0.46(0.10,51.00)	7.686	0.006
嵌顿时间[h,M(Q₁,Q₃)]	20.00(6.00,48.00)	18.00(6.00,24.00)	36.00(9.00,66.00)	2.521	0.112
疝环直径[cm,M(Q₁,Q₃)]	3.00(2.00,3.00)	3.00(3.00,3.00)	2.00(1.50,3.00)	6.427	0.011
腹腔积液[ml,M(Q₁,Q₃)]	1.00(1.00,150.00)	1.00(1.00,125.00)	100.00(1.00,287.50)	6.459	0.011
白细胞计数[M(Q₁,Q₃)]	9.20(7.00,11.37)	9.09(6.91,10.99)	10.00(7.96,13.17)	1.493	0.222
CRP[mg/L,M(Q₁,Q₃)]	1.58(0.10,11.66)	0.95(0.10,4.53)	29.24(6.79,39.39)	21.782	<0.001
肠梗阻[例(%)]				14.769	<0.001
无	63(62.38)	57(72.15)	6(27.27)
有	38(37.62)	22(27.85)	16(72.73)
疝的大小[例(%)]				30.160	<0.001
[0,5) cm	18(17.82)	10(12.66)	8(36.36)
[5,10) cm	56(55.45)	49(62.03)	7(31.82)
[10,15) cm	17(16.83)	17(21.52)	0(0.00)
[15,20) cm	6(5.94)	3(3.80)	3(13.64)
[20,25) cm	4(3.96)	0(0.00)	4(18.18)
疝囊有无压痛[例(%)]				0.640	0.800
有	80(79.2)	63(79.7)	17(77.3)
无	21(20.8)	16(20.3)	5(22.7)
疝的类型[例(%)]				4.363	0.113
斜疝	72(71.29)	58(73.42)	14(63.64)
直疝	11(10.89)	10(12.66)	1(4.55)
股疝	18(17.82)	11(13.92)	7(31.82)
还纳方式				101	0.413
术前还纳	38(37.62)	38(48.10)	0(0.00)
术中腔镜还纳	41(40.59)	41(51.90)	0(0.00)
中转开腹	9(8.91)	0(0.00)	9(40.91)
切除坏死肠管	13(12.87)	0(0.00)	13(59.09)

表2 TAPP治疗嵌顿性腹股沟疝中转开腹多因素分析

因素	B	SE	OR	95% CI	Z值	P值
患病时间	-0.094	0.087	0.91	0.77~1.08	-1.080	0.304
疝环直径	-0.071	0.052	0.93	0.84~1.03	-1.365	0.179
肠梗阻	0.105	0.097	1.11	0.93~1.33	1.082	0.26
腹腔积液	0.215	0.448	1.24	1.01~3.18	0.480	0.012
CRP	0.358	0.119	1.43	1.18~1.72	3.008	<0.001
性别	-0.05	0.119	0.95	0.74~1.22	-0.420	0.696
吸烟史	-0.102	0.078	0.9	0.78~1.05	-1.308	0.193

表2 TAPP治疗嵌顿性腹股沟疝中转开腹多因素分析

因素	B	SE	OR	95% CI	Z值	P值
患病时间	-0.094	0.087	0.91	0.77~1.08	-1.080	0.304
疝环直径	-0.071	0.052	0.93	0.84~1.03	-1.365	0.179
肠梗阻	0.105	0.097	1.11	0.93~1.33	1.082	0.26
腹腔积液	0.215	0.448	1.24	1.01~3.18	0.480	0.012
CRP	0.358	0.119	1.43	1.18~1.72	3.008	<0.001
性别	-0.05	0.119	0.95	0.74~1.22	-0.420	0.696
吸烟史	-0.102	0.078	0.9	0.78~1.05	-1.308	0.193

图1 中转开腹相关危险因素的预测模型注：图1A为以单因素分析中的危险因素绘成列线图模型，单独取值并进行求和，总和用于预测嵌顿性腹股沟疝中转开腹的发生概率；图1B为利用ROC曲线来判断该预测模型对嵌顿性腹股沟疝中转开腹的敏感性及特异性；图1C为预测该模型的校准曲线，曲线越接近对称线，预测准确率越高。

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Analysis of risk factors for conversion to laparotomy during laparoscopic trans-abdominal preperitoneal hernia repair surgery for incarcerated inguinal hernia

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Analysis of risk factors for conversion to laparotomy during laparoscopic trans-abdominal preperitoneal hernia repair surgery for incarcerated inguinal hernia