应用合成材料行腹壁疝无张力修补术后补片相关隐匿性肠瘘的研究

发布时间：2018-06-07 17:51

本文选题：无张力疝修补术 + 隐匿性肠瘘　；参考：《延安大学》2016年硕士论文

【摘要】：背景:腹壁疝无张力修补术以其操作简单,创伤小,恢复快,复发率低等优点,在全世界得到广泛应用。但随着其应用例数的增加,如术后感染、慢性疼痛、血清肿、肠瘘等并发症也时常可见报道,而补片相关肠瘘是腹壁疝无张力修补术后最严重的并发症。补片相关肠瘘的临床表现主要为补片迟发性深部感染,一般通过窦道造影、腹部CT等影像学检查可以确诊,术中也可发现明显肠瘘。但是随着临床病例的增多,我们发现还有一种特殊的补片相关肠瘘,这种肠瘘临床上首先表现为补片迟发性感染,但是术前未发现有肠液溢出,窦道造影检查也未见造影剂进入肠道,在手术去除感染补片中也未发现肠瘘症状,但在术后均出现较明显的肠瘘症状。这种肠瘘的发生,因术前及术中没有明显的临床表现,我们可称之为补片相关隐匿性肠瘘。目的:探讨合成材料行腹壁疝无张力修补术后补片相关隐匿性肠瘘的发生原因、诊断、治疗方法及预防。方法:收集陕西省人民医院普外一科2003-2014年共36例腹壁疝无张力修补术后补片感染患者,其中5例去除感染补片术后发生补片相关隐匿性肠瘘病例,对补片相关隐匿性肠瘘的病因、诊断、治疗及预防进行相关回顾性分析。结果:本组患者共5例,均在腹壁疝无张力修补术后发生补片感染,发生时间在术后3月-10年,这5例病例均在手术去除感染补片24-72h后引流管发现肠液,证明肠瘘发生,肠瘘量约为15-40 ml/d。发生肠瘘后5例病例均未手术,在给予充分引流、抗感染、营养支持后痊愈,随访3月未见异常。结论:腹壁疝无张力修补术后发生补片相关隐匿性肠瘘,由于其初始临床表现仅为补片迟发性深部感染,影像学检查无法发现,故而难以早期发现,通过窦道引流液细菌培养结果为肠道内菌群可以推测可能发生补片相关隐匿性肠瘘,确诊还需术后引流管内见到肠液。其发病原因可能与补片对肠管的侵蚀有关,但也不能排除术中手术操作因素。对于其治疗,保守治疗为上,充分的引流是肠瘘愈合的必要条件。预防补片相关隐匿性肠瘘,主要从其病因预防,如何防止补片对肠管的侵蚀是预防的关键,此外去除感染补片术中仔细操作,避免损伤肠管也是应该引起注意的方面。
[Abstract]:Background: tension-free repair of abdominal hernia has been widely used in the world because of its advantages of simple operation, small trauma, quick recovery and low recurrence rate. But with the increase in the number of cases, such as postoperative infection, chronic pain, serum swelling, intestinal fistula and other complications are often reported, and patch related intestinal fistula is the most serious complication after tension-free repair of abdominal wall hernia. The main clinical manifestation of patch associated intestinal fistula was delayed deep infection, which could be diagnosed by sinus angiography, abdominal CT and other imaging examinations, and obvious intestinal fistula could also be found during the operation. But as the number of clinical cases increased, we found that there was also a special patch-associated intestinal fistula, which was the first clinical manifestation of late infection of the patch, but there was no intestinal overflow before the operation. No contrast agent was found in the intestinal tract on sinus angiography, and no intestinal fistula was found in the surgical decontamination patch, but there were obvious symptoms of intestinal fistula after operation. The occurrence of this kind of intestinal fistula, because there is no obvious clinical manifestation before and during operation, we can call it patch-related occult intestinal fistula. Objective: to investigate the causes, diagnosis, treatment and prevention of occult intestinal fistula after tension-free repair of abdominal wall hernia with synthetic materials. Methods: a total of 36 patients with abdominal wall hernia after tension-free repair were collected from 2003 to 2014 in the Department of General Department of the people's Hospital of Shaanxi Province. The etiology, diagnosis, treatment and prevention of patch-related occult intestinal fistula were analyzed retrospectively. Results: all of the 5 cases had patch infection after tension-free repair of abdominal wall hernia, the time of occurrence was from 3 months to 10 years after operation. The intestinal fluid was found in the drainage tube 24 to 72 hours after the removal of the infected patch, which proved the occurrence of intestinal fistula. The amount of intestinal fistula was about 15-40 ml / d. No operation was performed in 5 cases after enteric fistula. The patients were cured with adequate drainage, anti-infection and nutritional support. No abnormality was found in the follow-up of 3 months. Conclusion: after tension-free repair of abdominal wall hernia, there is an occult intestinal fistula associated with patch repair. Because its initial clinical manifestation is only delayed deep infection, it is difficult to find it by imaging examination. According to the results of bacterial culture in the drainage fluid of the sinus tract, it can be speculated that there may be a patch related occult intestinal fistula in the intestinal flora, and it is necessary to see intestinal fluid in the drainage tube after operation for the diagnosis of the disease. The cause of the disease may be related to the erosion of intestinal canal by patch, but the operative factors can not be excluded. For its treatment, conservative treatment, adequate drainage is a necessary condition for the healing of intestinal fistula. In order to prevent the occult intestinal fistula associated with patch, the main prevention is from its etiology. The key of prevention is how to prevent the patch from eroding the intestinal tube. In addition, the careful operation during the operation of removing the infection patch and avoiding the injury of the intestinal tube should also be paid attention to.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R656.3

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