腹外疝修补术后补片感染13例病例报告并文献复习

发布时间：2018-04-26 23:15

本文选题：腹外疝 + 无张力修补术　；参考：《山东大学》2017年硕士论文

【摘要】：背景:腹外疝属于普外科的常见病及多发病之一,以腹股沟疝发病率最高,占腹外疝的90%-95%,此外,股疝、切口疝、脐疝等也是临床上较常见的腹外疝。腹外疝发生后,多无法自行愈合,手术是治疗腹外疝最有效的措施。但传统疝修补术缝合张力大,术后疼痛明显,且复发率高。自无张力修补术的概念提出后,腹外疝的预后获得明显改善,合成补片在临床上的应用也越来越广泛。然而由合成补片所带来的并发症(如补片感染、血清肿、肠粘连等)却成为临床上新的难题。补片感染的发生常常导致修补手术的失败,其治疗也较困难,是腹外疝修补术后严重并发症之一。但目前有关补片感染的病因、危险因素及预防措施仍缺乏足够的认识,对于补片感染的治疗也缺乏统一的标准。目的:分析腹外疝修补术后补片感染患者的临床资料,复习相关文献综述,对其危险因素、临床表现及诊疗过程进行总结,为补片感染的防治提供临床经验。方法:回顾性分析自2013年11月至2017年3月期间山东大学齐鲁医院收治的13例腹外疝修补术后补片感染的病例,对患者的临床资料,包括患者基本信息、病史资料、实验室检查、诊疗过程、随访情况等进行整理分析。结果:本研究13例患者中,男性10例,女性3例,男女比例为3.3:1。年龄分布为20-68岁,平均年龄为46.5±15.2岁,平均体重指数为26.1±4.4kg/m2。腹股沟疝9例,切口疝4例。患者临床表现中,发热2例,局部红肿1例,疼痛6例,窦道形成并脓性分泌物12例。患者的病程时间为41天至2年不等,中位时间为6个月(四分位间距为3.5至18个月)。13例患者经41天至2年不等的保守治疗均未获得治愈,而采取手术治疗。术后1例患者出现切口感染,经保守治疗获得痊愈。13例患者均经手术治疗获得治愈,随访时间4-36个月,中位时间12个月(四分位间距8.5至27.5个月),无复发病例。结论:1.患者自身因素、开放手术、急诊手术和手术切口感染可能会增加腹外疝修补术后补片感染发生的风险。2.补片感染多呈慢性病程,可表现为疼痛、局部红肿、窦道形成、脓性分泌物等局部症状,也可伴有发热等全身症状。3.补片感染的诊断主要依靠患者的病史及临床表现,实验室检查及超声、CT等影像学检查可辅助诊断。4.补片感染的治疗应遵循个体化原则,当长时间保守治疗不能获得痊愈时,应及时经手术移除感染补片。
[Abstract]:Background: external abdominal hernia is one of the most common diseases in general surgery. The incidence of inguinal hernia is the highest, accounting for 90-95% of external abdominal hernia. In addition, femoral hernia, incisional hernia, umbilical hernia and so on are also more common in clinic. Most of the external hernia can not heal by itself. Surgery is the most effective measure to treat the external hernia. But the traditional herniorrhaphy has great tension, obvious postoperative pain and high recurrence rate. Since the concept of tension-free repair was put forward, the prognosis of external abdominal hernia has been improved obviously, and the clinical application of composite patch has become more and more extensive. However, the complications (such as patch infection, serum swelling, intestinal adhesion, etc.) caused by synthetic patch have become a new clinical problem. The occurrence of patch infection often leads to the failure of repair operation, and its treatment is difficult, which is one of the serious complications after external abdominal hernia repair. However, the etiology, risk factors and preventive measures of patch infection are still lack of sufficient understanding, and there is also a lack of uniform standards for the treatment of patch infection. Objective: to analyze the clinical data, review the related literature, summarize the risk factors, clinical manifestations and diagnosis and treatment of the patients with the infection after repair of external abdominal hernia, so as to provide clinical experience for the prevention and treatment of the patch infection. Methods: from November 2013 to March 2017, 13 cases of external hernia repair were retrospectively analyzed in Qilu Hospital of Shandong University. The clinical data, including basic information, medical history and laboratory examination, were analyzed retrospectively. The diagnosis and treatment process and follow-up were analyzed. Results: of the 13 patients in this study, 10 were males and 3 females, with a ratio of 3.3: 1. The age distribution is 20-68 years old, the average age is 46.5 卤15.2 years old, the average body mass index is 26.1 卤4.4 kg / m2. Inguinal hernia 9 cases, incisional hernia 4 cases. There were 2 cases of fever, 1 case of local redness, 6 cases of pain, 12 cases of sinus formation and purulent secretion. The course of disease ranged from 41 days to 2 years, the median time was 6 months (quartile spacing was 3.5 to 18 months). 13 patients were not cured by conservative treatment ranging from 41 days to 2 years, but were treated surgically. Incision infection occurred in one patient after operation. All the 13 patients were cured by conservative treatment. The follow-up time was 4-36 months and the median time was 12 months (quartile interval 8.5 to 27.5 months). There were no recurrence cases. Conclusion 1. Patient factors, open surgery, emergency surgery, and surgical incision infection may increase the risk of patch infection after external herniorrhaphy. The infection of patch is mostly chronic disease, which can be shown as pain, local redness, sinus formation, purulent secretion and other local symptoms, but also accompanied by fever and other systemic symptoms. 3. The diagnosis of patch infection mainly depends on the patient's history and clinical manifestation. Laboratory examination and imaging examination such as ultrasound CT can assist the diagnosis. 4. The treatment of patch infection should follow the principle of individualization, and the infected patch should be removed in time when long time conservative treatment can not be cured.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R656.2

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