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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:
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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]. 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]. 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
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