腹腔镜腹股沟疝修补术后血清肿的危险因素及防治
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摘要
目的:探讨腹腔镜腹股沟疝修补术后血清肿的危险因素、预防及处理措施。方法:回顾分析2017年7月至2018年7月为91例腹股沟疝患者行腹腔镜疝修补术的临床资料,其中10例并发血清肿。对于患者年龄、性别、病程、疝囊大小、疝类型、手术方式、血红蛋白、白蛋白、术前合并症、手术时间与术后血清肿的相关性,进行单因素及多因素logistic回归分析。结果:单因素分析结果显示,血清肿组年龄(t=-2.172,P=0.032)大于无血清肿组,手术时间长于无血清肿组(t=-2.695,P=0.023);病程≥5年的患者血清肿发病率高于病程<5年者(χ~2=13.239,P<0.001);疝囊直径≥5 cm的患者血清肿发生率高于疝囊直径<5 cm者(χ~2=10.214,P=0.001)。多因素logistic回归分析结果显示手术时间、病程≥5年、疝囊直径≥5 cm是发生血清肿的独立危险因素。结论:手术时间、病程、疝囊大小是腹腔镜腹股沟疝修补术后发生血清肿的独立危险因素,个体化治疗、精准解剖与合理选择补片可降低血清肿发生率。
Objective:To explore the main risk factors,prevention and treatment of seroma after laparoscopic inguinal hernia repair.Methods:From Jul.2017 to Jul.2018,laparoscopic inguinal hernia repair was used in 91 patients of inguinal hernia.Among the included patients,10 cases were associated with seroma.The correlation of age,gender,duration of disease,hernia sac size,type of hernia,operation method,hemoglobin,albumin,perioperative comorbidity,operation time with the occurrence of seroma after laparoscopic inguinal hernia repair were observed,univariate and multivariate logistic regression analysis was performed.Results:Univariate analysis showed that the patients with seroma were significantly older than those without seroma(t=-2.172,P=0.032),and the operation time in seroma group was significantly longer than that in non-seroma group(t=-2.695,P=0.023).The incidence of seroma was significantly higher in the duration of disease≥5 years group when compared with the duration of disease <5 years group(χ~2=13.239,P<0.001).The incidence of seroma in hernia sac size ≥5 cm group was significantly higher than that in hernia sac size <5 cm group(χ~2=10.214,P=0.001).Multivariate logistic regression analysis showed that the operation time,the duration of disease≥5 years and hernia sac size≥5 cm were independent risk factors for seroma.Conclusions:The independent risk factors for seroma after laparoscopic inguinal hernia repair are operation time,duration of disease and hernia sac size.Personalized therapy,precise anatomy and appropriate selection of patch could reduce the incidence of seroma after laparoscopic inguinal hernia repair.
Objective:To explore the main risk factors,prevention and treatment of seroma after laparoscopic inguinal hernia repair.Methods:From Jul.2017 to Jul.2018,laparoscopic inguinal hernia repair was used in 91 patients of inguinal hernia.Among the included patients,10 cases were associated with seroma.The correlation of age,gender,duration of disease,hernia sac size,type of hernia,operation method,hemoglobin,albumin,perioperative comorbidity,operation time with the occurrence of seroma after laparoscopic inguinal hernia repair were observed,univariate and multivariate logistic regression analysis was performed.Results:Univariate analysis showed that the patients with seroma were significantly older than those without seroma(t=-2.172,P=0.032),and the operation time in seroma group was significantly longer than that in non-seroma group(t=-2.695,P=0.023).The incidence of seroma was significantly higher in the duration of disease≥5 years group when compared with the duration of disease <5 years group(χ~2=13.239,P<0.001).The incidence of seroma in hernia sac size ≥5 cm group was significantly higher than that in hernia sac size <5 cm group(χ~2=10.214,P=0.001).Multivariate logistic regression analysis showed that the operation time,the duration of disease≥5 years and hernia sac size≥5 cm were independent risk factors for seroma.Conclusions:The independent risk factors for seroma after laparoscopic inguinal hernia repair are operation time,duration of disease and hernia sac size.Personalized therapy,precise anatomy and appropriate selection of patch could reduce the incidence of seroma after laparoscopic inguinal hernia repair.
引文
[1] Sun J,Wang W,Li J,et al.Laparoscopic Experience for Recurrent Inguinal Hernia Repair in a Single Center for 14 Years[J].Am Surg,2018,84(3):344-350.
[2] Scheuermann U,Niebisch S,Lyros O,et al.Transabdominal Preperitoneal (TAPP) versus Lichtenstein operation for primary inguinal hernia repair-A systematic review and meta-analysis of randomized controlled trials[J].BMC Surg,2017,17(1):55.
[3] 中华医学会外科学分会疝与腹壁外科学组.腹股沟疝腹腔镜手术规范化操作指南[S].中国实用外科杂志,2013,33(7):566-570.
[4] Reiner MA,Bresnahan ER.Laparoscopic Total Extraperitoneal Hernia Repair Outcomes[J].JSLS,2016,20(3).pii:e2016.00043.
[5] 曾玉剑,孙亮,张同,等.连续1020例腹腔镜完全腹膜外腹股沟疝修补术的临床体会[J].中国普外基础与临床杂志,2015,22(2):190-194.
[6] 王平.腹腔镜腹部疝修补术术后血清肿分型的解读[J/CD].中华疝和腹壁外科杂志(电子版),2013,7(2):107-108.
[7] Piazzese EM,Galipò S,Mazzeo GI.Proposal of ecographic classification for seroma after laparoscopic ventral hernia repair[J].J Ultrasound,2014,18(4):349-360.
[8] 司仙科,李炜,杨佳华,等.负压引流在腹腔镜经腹腹膜前疝修补术后减少血清肿的临床应用[J/CD].中华疝与腹壁外科杂志(电子版),2018,12(1):30-33.
[9] Wong JC,Yang GP,Cheung TP,et al.Prospective randomized controlled trial comparing partially absorbable lightweight mesh and multifilament polyester anatomical mesh in laparoscopic inguinal hernia repair[J].Asian J Endosc Surg,2018,11(2):146-150.
[2] Scheuermann U,Niebisch S,Lyros O,et al.Transabdominal Preperitoneal (TAPP) versus Lichtenstein operation for primary inguinal hernia repair-A systematic review and meta-analysis of randomized controlled trials[J].BMC Surg,2017,17(1):55.
[3] 中华医学会外科学分会疝与腹壁外科学组.腹股沟疝腹腔镜手术规范化操作指南[S].中国实用外科杂志,2013,33(7):566-570.
[4] Reiner MA,Bresnahan ER.Laparoscopic Total Extraperitoneal Hernia Repair Outcomes[J].JSLS,2016,20(3).pii:e2016.00043.
[5] 曾玉剑,孙亮,张同,等.连续1020例腹腔镜完全腹膜外腹股沟疝修补术的临床体会[J].中国普外基础与临床杂志,2015,22(2):190-194.
[6] 王平.腹腔镜腹部疝修补术术后血清肿分型的解读[J/CD].中华疝和腹壁外科杂志(电子版),2013,7(2):107-108.
[7] Piazzese EM,Galipò S,Mazzeo GI.Proposal of ecographic classification for seroma after laparoscopic ventral hernia repair[J].J Ultrasound,2014,18(4):349-360.
[8] 司仙科,李炜,杨佳华,等.负压引流在腹腔镜经腹腹膜前疝修补术后减少血清肿的临床应用[J/CD].中华疝与腹壁外科杂志(电子版),2018,12(1):30-33.
[9] Wong JC,Yang GP,Cheung TP,et al.Prospective randomized controlled trial comparing partially absorbable lightweight mesh and multifilament polyester anatomical mesh in laparoscopic inguinal hernia repair[J].Asian J Endosc Surg,2018,11(2):146-150.