腹股沟疝修补术后补片相关感染的处理
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摘要
目的研究分析腹股沟疝修补术后补片相关感染的治疗及预防。方法选取2015年1月至2017年12月在中山大学附属第六医院接受手术的20例腹股沟疝修补术后补片感染病人作为研究对象,分析总结腹股沟疝修补术后补片感染的外科处理方法与临床经验。结果 20例病人均成功手术治疗。开放手术17例中12例行一期缝合,术后切口感染6例,感染率为50%,其中1例补片残留感染再次手术取补片,5例取补片后伤口敞开引流,二期缝合;腹腔镜手术3例,其中1例放置补片后感染再次手术取补片,最后均治愈出院。全部病例随访3～29个月,平均随访15个月,均未出现伤口感染、补片残留感染,1例病人于术后3个月出现腹股沟疝复发,再次行疝修补。结论在行腹股沟疝无张力修补术后,补片感染影响因素众多,通过手术取出感染补片是补片感染的有效治疗手段。
Objective To study the treatment and prevention of mesh infection after inguinal hernia repair.Methods Twenty patients with mesh infection after inguinal hernia repair in the Sixth Affiliated Hospital of Sun Yat-sen University from January 2015 to December 2017 were selected as the study objects.Surgical treatment and clinical experience were analyzed.Results Twenty patients underwent surgical treatment.Among the 17 cases of open surgery, 12 cases underwent one-stage suturing and 6 cases were infected after incision closed.The infection rate was 50%.One case was given re-operation because of mesh residual infection.The wound was opened for drainage after the the meshes were removed in 5 cases, and the second-stage suturing was done.Of 3 cases receiving laparoscopic surgery, re-operation was done for meth removal due to meth infection in 1 case.The average follow-up time was 15(3-29) months.There were no wound infection and mesh residue infection.One patient developed inguinal hernia recurrence 3 months after operation, and hernia repair was performed again.Conclusion There are many influencing factors of mesh infection after tension-free repair of inguinal hernia.Removal of infected mesh by surgery is an effective treatment for mesh infection.
Objective To study the treatment and prevention of mesh infection after inguinal hernia repair.Methods Twenty patients with mesh infection after inguinal hernia repair in the Sixth Affiliated Hospital of Sun Yat-sen University from January 2015 to December 2017 were selected as the study objects.Surgical treatment and clinical experience were analyzed.Results Twenty patients underwent surgical treatment.Among the 17 cases of open surgery, 12 cases underwent one-stage suturing and 6 cases were infected after incision closed.The infection rate was 50%.One case was given re-operation because of mesh residual infection.The wound was opened for drainage after the the meshes were removed in 5 cases, and the second-stage suturing was done.Of 3 cases receiving laparoscopic surgery, re-operation was done for meth removal due to meth infection in 1 case.The average follow-up time was 15(3-29) months.There were no wound infection and mesh residue infection.One patient developed inguinal hernia recurrence 3 months after operation, and hernia repair was performed again.Conclusion There are many influencing factors of mesh infection after tension-free repair of inguinal hernia.Removal of infected mesh by surgery is an effective treatment for mesh infection.
引文
[1] 中华医学会外科学分会疝和腹壁外科学组.中国医师协会外科医师分会疝和腹壁外科医师委员会成人腹股沟疝诊疗指南(2014年版)[J/CD].中华疝和腹壁外科杂志(电子版),2014,8(3):204-206.
[2] Eriksen JR, Gogenur I, Rosenberg J.Choice of mesh for laparoscopic ventral hernia repair [J].Hernia,2007, 11 (4):481-492.DOI:10.1007/s10029-007-0282-8.
[3] Hawn MT, Snyder CW, Graham LA, et al.Long-term follow-up of technical outcomes for incisional Hernia repair [J].J Am Coll Surg, 2010, 210 (5):648-655.DOI:10.1016/j.jamcollsurg.2009.12.038.
[4] 陈涛,李新星.迟发性深部补片感染的研究现状[J].外科理论与实践,2014,19(2):183-184.DOI:10.3969/j.issn.1007-1096.2014.02.024.
[5] Cobb WS, Carbonell AM, Kalbaugh CL, et al.Infection risk of open placement of intraperitoneal composite mesh [J].Am Surg, 2009, 75 (9):762-767.
[6] 顾岩.腹壁疝人工合成补片植入所致感染的防治[J].外科理论与实践,2010,15 (6):586-589.
[7] Gillion JF, Palot JP.Abdominal wall incisional hernias:infected prosthesis:treatment and prevention [J].J Visc Surg,2012,149(5 Suppl):e20-e31.DOI:10.1016/j.jviscsurg.2012.04.003.
[8] Narkhede R, Shah NM, DalalPR,et al.Postoperative Mesh Infection Still a Concern in Laparoscopic Era [J]. Indian J Surg,2015,77(4):322-326.DOI:10.1007/s12262-015-1304-x.
[9] Tolino MJ, Tripoloni DE, Ratto R, et al.Infections associated with prosthetic repairs of abdominal wall hernia:pathology, management and results [J].Hernia, 2009, 13 (6):631-637.DOI:10.1007/s10029-009-0541-y.
[10] Miller G.Promising agent emerging to battle mesh infections [J].Gen Surg News, 2010,37 (1):16-17.
[11] Lauwers P, Bracke B, Hubens G, et al.Unusual complications of preperitoneal mesh implantation in the treatment of inguinal hernia [J].Acta Chir Belg, 2003, 103(5):513-516.
[12] Hamouda A, Kennedy J, Grant N, et al.Mesh erosion into the urinary bladder following laparoscopic inguinal hernia repair; is this the tip of the iceberg? [J].Hernia, 2010, 14(3):317-319.DOI:10.1007/s10029-009-0539-5.
[13] Rehman S, Khan S, Pervaiz A, et al.Recurrence of inguinal hernias following removal of infected prosthetic meshes:a review of the literature [J].Hernia,2011,16(2):123-126.DOI:10.1007/s10029-011-0873-2.
[14] Fawole AS, Chaparala RP, Ambrose NS.Fate of the inguinal hernia following removal of infected prosthetic mesh [J].Hernia, 2006,10 (1):58-61.DOI:10.1007/s10029-005-0031-9.
[15] 陈革,唐健雄,黄磊.生物补片在治疗感染和污染腹壁缺损方面的体会(附 34 例病例)[J].中华疝和腹壁外科杂志,2011,5 (4):389-393.DOI:10.3877/cma.j.issn.1674-392X.2011.04.002.
[16] Lee L, Mata J,Landry T,et al.A systematic review of synthetic and biologic materials for abdominal wall reinforcement in contaminated fields[J].Surg Endosc,2014,28(9):2531-2546.DOI:10.1007/s00464-014-3499-5.
[17] 宗振,江志鹏,侯泽辉.自制负压封闭引流装置治疗腹股沟疝术后补片感染疗效分析[J].中国实用外科杂志,2016,36 (5):569-570.DOI:10.7504/CJPS.ISSN1005-2208.2016.05.27.
[2] Eriksen JR, Gogenur I, Rosenberg J.Choice of mesh for laparoscopic ventral hernia repair [J].Hernia,2007, 11 (4):481-492.DOI:10.1007/s10029-007-0282-8.
[3] Hawn MT, Snyder CW, Graham LA, et al.Long-term follow-up of technical outcomes for incisional Hernia repair [J].J Am Coll Surg, 2010, 210 (5):648-655.DOI:10.1016/j.jamcollsurg.2009.12.038.
[4] 陈涛,李新星.迟发性深部补片感染的研究现状[J].外科理论与实践,2014,19(2):183-184.DOI:10.3969/j.issn.1007-1096.2014.02.024.
[5] Cobb WS, Carbonell AM, Kalbaugh CL, et al.Infection risk of open placement of intraperitoneal composite mesh [J].Am Surg, 2009, 75 (9):762-767.
[6] 顾岩.腹壁疝人工合成补片植入所致感染的防治[J].外科理论与实践,2010,15 (6):586-589.
[7] Gillion JF, Palot JP.Abdominal wall incisional hernias:infected prosthesis:treatment and prevention [J].J Visc Surg,2012,149(5 Suppl):e20-e31.DOI:10.1016/j.jviscsurg.2012.04.003.
[8] Narkhede R, Shah NM, DalalPR,et al.Postoperative Mesh Infection Still a Concern in Laparoscopic Era [J]. Indian J Surg,2015,77(4):322-326.DOI:10.1007/s12262-015-1304-x.
[9] Tolino MJ, Tripoloni DE, Ratto R, et al.Infections associated with prosthetic repairs of abdominal wall hernia:pathology, management and results [J].Hernia, 2009, 13 (6):631-637.DOI:10.1007/s10029-009-0541-y.
[10] Miller G.Promising agent emerging to battle mesh infections [J].Gen Surg News, 2010,37 (1):16-17.
[11] Lauwers P, Bracke B, Hubens G, et al.Unusual complications of preperitoneal mesh implantation in the treatment of inguinal hernia [J].Acta Chir Belg, 2003, 103(5):513-516.
[12] Hamouda A, Kennedy J, Grant N, et al.Mesh erosion into the urinary bladder following laparoscopic inguinal hernia repair; is this the tip of the iceberg? [J].Hernia, 2010, 14(3):317-319.DOI:10.1007/s10029-009-0539-5.
[13] Rehman S, Khan S, Pervaiz A, et al.Recurrence of inguinal hernias following removal of infected prosthetic meshes:a review of the literature [J].Hernia,2011,16(2):123-126.DOI:10.1007/s10029-011-0873-2.
[14] Fawole AS, Chaparala RP, Ambrose NS.Fate of the inguinal hernia following removal of infected prosthetic mesh [J].Hernia, 2006,10 (1):58-61.DOI:10.1007/s10029-005-0031-9.
[15] 陈革,唐健雄,黄磊.生物补片在治疗感染和污染腹壁缺损方面的体会(附 34 例病例)[J].中华疝和腹壁外科杂志,2011,5 (4):389-393.DOI:10.3877/cma.j.issn.1674-392X.2011.04.002.
[16] Lee L, Mata J,Landry T,et al.A systematic review of synthetic and biologic materials for abdominal wall reinforcement in contaminated fields[J].Surg Endosc,2014,28(9):2531-2546.DOI:10.1007/s00464-014-3499-5.
[17] 宗振,江志鹏,侯泽辉.自制负压封闭引流装置治疗腹股沟疝术后补片感染疗效分析[J].中国实用外科杂志,2016,36 (5):569-570.DOI:10.7504/CJPS.ISSN1005-2208.2016.05.27.