切换至 "中华医学电子期刊资源库"
高级检索
中华危重症医学杂志(电子版)

中华危重症医学杂志(电子版) ›› 2017, Vol. 10 ›› Issue (05) : 328 -333. doi: 10.3877/cma.j.issn.1674-6880.2017.05.007

所属专题： 文献；

论著

腹股沟疝修补术后腹膜前间隙出血危险因素分析及急诊处理
黄永刚1, 叶静1, 张方捷1, 吴浩1, 高国栋1, 王平1,†()   
  1. 1. 310006　杭州，杭州市第一人民医院疝和腹壁外科
  • 收稿日期:2017-04-10 出版日期:2017-10-01
  • 通信作者: 王平

Risk factors and emergency treatment of preperitoneal space hemorrhage after inguinal hernia repair

Yonggang Huang1, Jing Ye1, Fangjie Zhang1, Hao Wu1, Guodong Gao1, Ping Wang1,†()   

  1. 1. Department of Hernia and Abdominal Wall Surgery, Hangzhou First People's Hospital, Hangzhou, 310006, China
  • Received:2017-04-10 Published:2017-10-01
  • Corresponding author: Ping Wang
  • About author:
    Corresponding author: Wang Ping, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

黄永刚, 叶静, 张方捷, 吴浩, 高国栋, 王平. 腹股沟疝修补术后腹膜前间隙出血危险因素分析及急诊处理[J/OL]. 中华危重症医学杂志(电子版), 2017, 10(05): 328-333.

Yonggang Huang, Jing Ye, Fangjie Zhang, Hao Wu, Guodong Gao, Ping Wang. Risk factors and emergency treatment of preperitoneal space hemorrhage after inguinal hernia repair[J/OL]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2017, 10(05): 328-333.

目的

探讨腹股沟疝患者行腹膜前修补术后腹膜前间隙出血的危险因素及急诊处理。

方法

选取2012年1月至2016年12月杭州市第一人民医院疝和腹壁外科收治的2 096例腹股沟疝患者行腹膜前修补手术，经腹部CT明确术后腹膜前间隙出血。将38例明确为腹膜前间隙出血的患者纳入病例组，76例未出血腹股沟疝腹膜前修补手术患者纳入对照组。对两组患者的一般资料进行比较，采用Logistic多元回归分析腹股沟疝腹膜前修补术后腹膜前间隙出血的危险因素。

结果

病例组患者中37例经非手术治疗后痊愈，成功率为97.37%（37/38）。两组腹股沟疝腹膜前修补手术患者在住院时间[（9.1 ± 3.3）d vs.（5.8 ± 2.5）d，t = 3.282，P = 0.037]、术前抗凝（26/38 vs. 25/76，χ2 = 4.271，P = 0.002）、复发疝（22/38 vs. 25/76，χ2 = 3.450，P = 0.019）、手术时间延长（24/38 vs. 17/76，χ2 = 4.628，P = 0.004）、学习曲线早期（30/38 vs. 15/76，χ2 = 0.655，P = 0.013）、血红蛋白下降幅度[（36 ± 13）g/L vs.（22 ± 7）g/L，t = 24.21，P < 0.001]及血压下降幅度[（34 ± 9）mmHg vs.（17 ± 8）mmHg，t = 0.219，P = 0.006]方面比较，差异均有统计学意义。将上述有统计学差异的指标纳入Logistic多元回归分析。结果显示，术前抗凝[OR = 4.759，95%CI（1.286，17.606），P = 0.019]、复发疝[OR = 2.203，95%CI（1.051，6.818），P = 0.025]、手术时间延长[OR = 3.219，95%CI（1.060，4.792），P = 0.021]、学习曲线早期[OR = 13.814，95%CI（3.731，51.146），P < 0.001]、血红蛋白下降幅度[OR = 26.255，95%CI（4.688，56.343），P = 0.020]及血压下降幅度[OR = 34.091，95%CI（11.494，82.442），P < 0.001]为腹股沟疝腹膜前修补术后腹膜前间隙出血的危险因素。

结论

腹股沟疝修补术后腹膜前间隙出血采用非手术治疗是安全有效的。术前抗凝、复发疝、手术时间延长、学习曲线早期、血红蛋白下降幅度及血压下降幅度是腹股沟疝修补术后腹膜前间隙出血的危险因素。

关键词: 疝，腹股沟, 腹膜前间隙, 出血, 危险因素
Objective

To investigate risk factors and emergency treatment of inguinal hernia patients with preperitoneal space hemorrhage after preperitoneal repair surgery.

Methods

A total of 2 096 patients with inguinal hernia in Department of Hernia and Abdominal Wall Surgery of Hangzhou First People's Hospital from January 2012 to December 2016 were treated with preperitoneal repair surgery and used abdominal CT to diagnose their preperitoneal space hemorrhage. Thirty-eight patients with preperitoneal space hemorrhage were included in the case group, and 76 patients without preperitoneal space hemorrhage were included in the control group. The general data of two groups were compared, and the risk factors for preperitoneal space hemorrhage after preperitoneal repair of inguinal hernia were analyzed by Logistic multivariate regression analysis.

Results

Thirty-seven cases in the case group were cured by non-surgical treatment, and the success rate was 97.37% (37/38). The length of stay [(9.1 + 3.3) d vs. (5.8 + 2.5) d, t = 3.282, P = 0.037], preoperative anticoagulation (26/38 vs. 25/76, χ2 = 4.271, P = 0.002), recurrent hernia (22/38 vs. 25/76, χ2 = 3.450, P = 0.019), prolonged operation time (24/38 vs. 17/76, χ2 = 4.62 8, P = 0.004), the early learning curve (30/38 vs. 15/76, χ2 = 0.655, P = 0.013), decreased hemoglobin [(36 + 13) g/L vs. (22 + 7) g/L, t = 24.21, P < 0.001] and declined blood pressure [(34 + 9) mmHg vs. (17 + 8) mmHg, t = 0.219, P = 0.006] of these two groups were statistically different. These statistically different indicators were included in the Logistic multivariate regression analysis. The results showed that preoperative anticoagulation [OR = 4.759, 95%CI (1.286, 17.606), P = 0.019], recurrent hernia [OR = 2.203, 95%CI (1.051, 6.818), P = 0.025], prolonged operation time [OR = 3.219, 95%CI (1.060, 4.792), P = 0.021], the early learning curve [OR = 13.814, 95%CI (3.731, 51.146), P < 0.001], decreased hemoglobin [OR = 26.255, 95%CI (4.688, 56.343), P = 0.020] and declined blood pressure [OR = 34.091, 95%CI (11.494, 82.442), P < 0.001] were the risk factors of preperitoneal space hemorrhage after preperitoneal repair of inguinal hernia.

Conclusions

Non-surgical treatment is safe and effective in preperitoneal space hemorrhage after inguinal hernia repair surgery. Preoperative anticoagulation, recurrent hernia, prolonged operation time, the early learning curve, decreased hemoglobin and declined blood pressure were the risk factors of preperitoneal space hemorrhage after inguinal hernia repair surgery.

Key words: Hernia, inguinal, Preperitoneal space, Hemorrhage, Risk factors
表1 两组腹股沟疝腹膜前修补手术患者一般资料比较
组别 例数 BMI（例） 住院时间（d， ± s） 手术方式（例） 术前抗凝（例） 血红蛋白下降幅度（g/L， ± s） 血压下降幅度（mmHg， ± s）
消瘦 正常 肥胖 开放 TAPP TEP
病例组 38 6 18 14 9.1 ± 3.3 8 18 12 12 36 ± 13 34 ± 9
对照组 76 16 34 26 5.8 ± 2.5 37 31 8 8 22 ± 7 17 ± 8
t/χ2值 ? 0.547 3.282 3.710 4.271 24.210 0.219
P值 ? 0.880 0.037 0.907 0.002 < 0.001 0.006
组别 例数 原发疝（例） 复发疝（例） 手术时间延长（≥ 60 min，例） 学习曲线早期（< 50例，例） 补片固定方式（例） 疝囊处理方式（例）
枪钉 缝合 胶水或不固定 横断 剥离
病例组 38 16 22 24 30 19 2 17 15 23
对照组 76 51 25 17 15 37 5 34 29 47
t/χ2值 ? 1.720 3.450 4.628 0.655 0.068 0.135
P值 ? 0.116 0.019 0.004 0.013 0.794 0.792
表2 腹股沟疝腹膜前修补术后腹膜前间隙出血危险因素分析
危险因素 回归系数 标准误 Wald值 OR值 95%CI P值
住院天数（d） 1.080 1.393 0.626 0.340 0.272 ~ 0.783 0.871
术前抗凝 1.560 0.667 5.462 4.759 1.286 ~ 17.606 0.019
复发疝 1.592 0.710 5.030 2.203 1.051 ~ 6.818 0.025
手术时间延长（≥ 60 min） 1.521 0.657 5.356 3.219 1.060 ~ 4.792 0.021
学习曲线早期（< 50例） 2.626 0.668 15.456 13.814 3.731 ~ 51.146 < 0.001
血红蛋白下降幅度（g/L） 4.194 1.351 9.631 26.255 4.688 ~ 56.343 0.020
血压下降幅度（mmHg） 5.412 1.496 13.094 34.091 11.494 ~ 82.442 < 0.001
1
唐健雄. 腹股沟疝无张力修补手术的规范化问题[J]. 中华普通外科杂志，2011，26(2):89-90.
2
Read RC. Crucial steps in the evolution of the preperitoneal approaches to the groin: an historical review[J]. Hernia, 2011, 15 (1): 1-5.
3
Wolloscheck T, Konerding MA. Dimensions of the myopectineal orifice: a human cadaver study[J]. Hernia, 2009, 13 (6): 639-642.
4
Pélissier EP, Blum D, Marre P, et al. Inguinal hernia: a patch covering only the myopectineal orifice is effective[J]. Hernia, 2001, 5 (2): 84-87.
5
杜忠民. 老年男性急性脑出血患者的CT特征及临床预后[J/CD]. 中华危重症医学杂志（电子版），2017，10(2):119-121.
6
复旦大学附属中山医院围手术期处理多学科团队. 接受抗凝药物治疗的普外科病人围手术期处理--中山共识（1）[J]. 中国实用外科杂志，2013，33(1):1-3.
7
中华医学会外科学分会疝和腹壁外科学组. 成人腹股沟疝、股疝和腹部手术切口疝手术治疗方案（2003年修订稿）[J]. 中华外科杂志，2004，42(14):834-835.
8
陆远强. 失血性休克患者的液体复苏策略分析[J/CD]. 中华危重症医学杂志（电子版），2011，4(1):7-12.
9
陆远强，黄卫东. 高渗氯化钠溶液复苏失血性休克的研究进展[J/CD]. 中华危重症医学杂志（电子版），2010，3(4):228-233.
10
Simons MP, Aufenacker T, Bay-Nielsen M, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients[J]. Hernia, 2009, 13 (4): 343-403.
11
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]. 中华外科杂志，2014，52(7):481-484.
12
Ates M, Kinaci E, Kose E, et al. Corona mortis: in vivo anatomical knowledge and the risk of injury in totally extraperitoneal inguinal hernia repair[J]. Hernia, 2016, 20 (5): 659-665.
13
Pungpapong SU, Thum-umnauysuk S. Incidence of corona mortis; preperitoneal anatomy for laparoscopic hernia repair[J]. J Med Assoc Thai, 2005, 88 Suppl 4: S51-53.
14
宗华，潘凯，陶红光，等. 腹腔镜腹股沟疝修补术中出血控制及解剖分析[J/CD]. 中华疝和腹壁外科杂志（电子版），2016，10(1):34-38.
15
Smoot RL, Oderich GS, Taner CB, et al. Postoperative hematoma following inguinal herniorrhaphy: patient characteristics leading to increased risk[J]. Hernia, 2008, 12 (3): 261-265.
16
Zeb MH, Pandian TK, El Khatib MM, et al. Risk factors for postoperative hematoma after inguinal hernia repair: an update[J]. J Surg Res, 2016, 205 (1): 33-37.
17
Paajanen H, Scheinin T, Vironen J. Commentary: Nationwide analysis of complications related to inguinal hernia surgery in Finland: a 5 year register study of 55,000 operations[J]. Am J Surg, 2010, 199 (6): 746-751.
18
Suguita FY, Essu FF, Oliveira LT, et al. Learning curve takes 65 repetitions of totally extraperitoneal laparoscopy on inguinal hernias for reduction of operating time and complications[J]. Surg Endosc, 2017. [Epub ahead of print].
19
Kockerling F, Roessing C, Adolf D, et al. Has endoscopic (TEP, TAPP) or open inguinal hernia repair a higher risk of bleeding in patients with coagulopathy or antithrombotic therapy? Data from the Herniamed Registry[J]. Surg Endosc, 2016, 30 (5): 2073-2081.
20
Wakasugi M, Akamatsu H, Yoshidome K, et al. Totally extraperitoneal inguinal hernia repair in patients on antithrombotic therapy: a retrospective analysis[J]. Surg Today, 2013, 43 (8): 942-945.
21
Dulucq JL, Wintringer P, Mahajna A. Laparoscopic totally extraperitoneal inguinal hernia repair: lessons learned from 3 100 hernia repairs over 15 years[J]. Surg Endosc, 2009, 23 (3): 482-486.
22
Tonolini M. Multidetector CT of expected findings and complications after contemporary inguinal hernia repair surgery[J]. Diagn Interv Radiol, 2016, 22 (5): 422-429.
23
Pochhammer J, Lang S, Scuffi B, et al. Are routine ultrasound examinations helpful in the detection of bleeding complications following laparoscopic inguinal hernia repair?[J]. J Clin Ultrasound, 2017, 45 (3): 145-149.
[1] 贺斌, 马晋峰. 胃癌脾门淋巴结转移危险因素[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 694-699.
[2] 马东扬, 李斌, 陆安清, 王光华, 雷文章, 宋应寒. Gilbert 与单层补片腹膜前疝修补术疗效的随机对照研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 629-633.
[3] 林凯, 潘勇, 赵高平, 杨春. 造口还纳术后切口疝的危险因素分析与预防策略[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 634-638.
[4] 周正阳, 陈凯, 仇多良, 邵乐宁, 吴浩荣, 钟丰云. 腹腔镜腹股沟疝修补术后出血原因分析及处理[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 660-664.
[5] 顾熙, 徐子宇, 周澍, 张吴楼, 张业鹏, 林昊, 刘宗航, 嵇振岭, 郑立锋. 腹股沟疝腹膜前间隙无张力修补术后补片感染10 例报道[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 665-669.
[6] 宋俊锋, 张珍珍. 单侧初发性腹股沟斜疝老年患者经腹腹膜前疝修补术中残余疝囊腹直肌下缘固定效果评估[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 670-674.
[7] 高娟, 徐建庆, 闫芳, 丁盛华, 刘霞. Rutkow、TAPP、TEP 手术治疗单侧腹股沟疝患者的临床疗效及对血清炎症因子水平的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 675-680.
[8] 于新峰, 曾琦, 后强, 徐浩, 操谢芳. 腹腔镜经腹腹膜前疝修补术和腹腔镜完全腹膜外疝修补术对成人腹股沟疝治疗效果及预后分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 681-686.
[9] 杨闯, 马雪. 腹壁疝术后感染的危险因素分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 693-696.
[10] 方辉强, 黄杰, 随冰琰. 腰方肌阻滞与腹横肌平面阻滞对腹股沟疝腹腔镜手术患者术后镇痛效果的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 697-702.
[11] 朱佳琳, 方向, 贵诗雨, 黄丹, 周小雨, 郭文恺. 大鼠切口疝腹膜前间隙补片修补术后血清中VEGF 和Ang-1 的表达情况[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 703-707.
[12] 张晋伟, 董永红, 王家璇. 基于GBD2021 数据库对中国与全球老年人疝疾病负担和健康不平等的分析比较[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 708-716.
[13] 杭轶, 杨小勇, 李文美, 薛磊. 可控性低中心静脉压技术在肝切除术中应用的最适中心静脉压[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 813-817.
[14] 吴广迎, 张延娟, 秦鹏, 卢艳丽. 经颈静脉肝内门体静脉分流术预防上消化道出血的临床研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 545-548.
[15] 颜世锐, 熊辉. 感染性心内膜炎合并急性肾损伤患者的危险因素探索及死亡风险预测[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 618-624.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号