本文選題：嵌頓疝 + 腸壞死�。� 參考：《山東大學》2014年博士論文

【摘要】：第一部分嵌頓疝動物模型的建立與腸壞死程度系統(tǒng)評價 研究背景及目的 腸壞死可表現(xiàn)為早期的非特異性癥狀和晚期延遲性特異性癥狀。臨床中各種原因?qū)е碌哪c缺血性疾病均可導致腸壞死,而嵌頓疝作為常見的導致腸缺血疾病之一,如不能及時解除嵌頓,可以導致腸絞窄壞死,最終導致局部及全身嚴重的臨床后果。 就單純評價腸管壞死程度而言,腸管壁可以由粘膜、肌層到透壁性全層梗死過渡,但作為人體系統(tǒng)而言,嵌頓疝所導致的腸壞死除腸管組織形態(tài)學改變外,可導致局部炎癥(紅腫,甚至蜂窩織炎、腸外瘺)、腸梗阻、腹膜炎、感染性休克等局部及全身的表現(xiàn)。究其原因是隨著壞死時間的延長腸壞死程度是不同的,所導致的臨床后果不同,同時處理方式及預后不同。 目前的實驗室檢查因為缺乏特異性,尚沒有一種快速且可靠的檢測指標來預測腸缺血并判定腸壞死時間,臨床中更沒有一種系統(tǒng)來評判腸壞死的程度。因為嵌頓疝導致的腸壞死與其他原因?qū)е碌哪c壞死臨床表現(xiàn)不同,比較適合建立一種系統(tǒng)來評價腸壞死的程度并體現(xiàn)該病的進展過程。本研究的目的為建立一種大鼠腹壁嵌頓疝模型,模擬腸絞窄壞死的過程,觀察腸壞死后局部及全身表現(xiàn)并系統(tǒng)賦分,為臨床中嵌頓疝腸壞死程度分級的建立提供實驗依據(jù)。方法 選取成年健康雄性Wistar大鼠,制作腹壁嵌頓疝動物模型。根據(jù)腸管嵌頓時間的增加,依次將模型分為12組,嵌頓時間自2h起,分別于2h、4h、6h、8h、12h、16h、20h、24h、28h、32h、36h、36h作為時間節(jié)點處死大鼠,依據(jù)不同時間節(jié)點的壞死腸管形態(tài)及組織學觀察、局部炎癥及全身表現(xiàn)等對腸管壞死的程度進行系統(tǒng)賦分,比較與對照組及各組之間腸管壞死程度的差異。 結(jié)果 1.腸管損傷在嵌頓時間4-6h實現(xiàn)組織學全層壞死,腹部可出現(xiàn)腸梗阻體征。嵌頓時間16h,腸管可破潰,局部呈炎癥表現(xiàn)并查見細菌,腹部可有腹膜炎表現(xiàn)。嵌頓時間超過32h嵌頓腸管形態(tài)消失,局部可呈蜂窩織炎,至72h左右大鼠逐步休克死亡。 2.與對照組比較,各實驗組腸管壞死系統(tǒng)評分依嵌頓時間遞增排序,至嵌頓時間超過36h直至大鼠死亡,系統(tǒng)評分達最高值。各實驗組間,嵌頓時間相差8h及以上者,系統(tǒng)評分存在明顯的差異；且嵌頓4-6h組間、16-20h組間、32-36h組間系統(tǒng)評分有顯著性差異,P值均小于0.05。 結(jié)論 1.本實驗制備的大鼠腹壁嵌頓疝模型較好地模擬了腸管絞窄到壞死的過程,同時呈現(xiàn)了該過程中臨床表現(xiàn)及最終結(jié)局。 2.隨著嵌頓時間的延長,腸壞死系統(tǒng)評分呈現(xiàn)出較明顯的時間相關性,腸壞死系統(tǒng)評分可以客觀反映嵌頓疝腸壞死的病情進展。 第二部分嵌頓疝腸壞死程度臨床分級的建立與患者臨床特點的關系研究背景及目的 臨床中嵌頓疝需要緊急的外科干預治療,但是非擇期情況下其手術的并發(fā)癥及死亡率增加。腹股溝疝嵌頓后作為常見外科急腹癥能顯著增加腸梗阻及腸絞窄風險。大約15%的腹股溝嵌頓疝患者可發(fā)展為腸壞死而不得不行腸切除,其死亡率達5%。 雖然嵌頓疝絞窄后的最終結(jié)局是腸壞死,但隨著壞死時間的延長,其局部及全身癥狀及體征是不同的。壞死早期,絞窄的腸管雖然已部分或全層壞死,但尚未發(fā)生穿孔,手術區(qū)域和腹腔也未受到明確或明顯的污染,局部及全身癥狀較輕。但是在壞死后期,腸管可以形態(tài)消失或穿孔,局部可表現(xiàn)為蜂窩織炎,創(chuàng)面屬于明確污染或感染傷口；腹部可表現(xiàn)為腸梗阻、腹膜炎；全身可表現(xiàn)為感染性休克甚至死亡。所以作為系統(tǒng)而言,嵌頓疝腸壞死程度是不同的,相應的臨床結(jié)局及處理方式不同。但目前臨床中尚無對腸壞死程度的系統(tǒng)定義。 在之前的研究中我們通過動物實驗對大鼠腹壁嵌頓疝腸壞死病情進展進行初步觀察與系統(tǒng)評價分析。本研究是在臨床中通過對腹股溝嵌頓疝并發(fā)腸壞死患者腸管形態(tài)學、局部及全身癥狀及體征的臨床觀察,目的建立一種腸壞死分級系統(tǒng)來客觀反映腸壞死的程度,分析腸壞死分級與患者臨床特點關系,尤其是與患者預后的關系。研究方法 對2003年1月至2013年1月期間的所有急癥入院并手術治療的成人嵌頓疝患者進行前瞻性并排除性研究,對符合納入研究標準的腹股溝嵌頓疝并發(fā)腸壞死患者的局部及全身表現(xiàn)進行系統(tǒng)觀察,根據(jù)嵌頓時間、腸管壞死后形態(tài)、疝囊的完整性及疝外被蓋組織的炎癥程度、疝內(nèi)容物性狀,有無腸梗阻、腹膜炎及休克體征等,對腸壞死程度進行臨床分級,分析影響腸壞死分級的臨床因素以及腸壞死分級與患者預后的關系。結(jié)果 1.共有68例患者納入本研究并據(jù)其建立3級腸壞死分級系統(tǒng),共有49例(72.1%)Ⅰ級壞死患者,14例(20.1%)Ⅱ級壞死患者,5例(7.4%)Ⅲ級壞死患者。術后并發(fā)癥及死亡率分別為32.4%和7.4%。 2.年齡≥65歲(P=0.035)、伴隨疾病(P=0.008)和高ASA評分(P=0.014)是導致腸壞死程度加重而影響腸壞死分級的因素。 3.隨著腸壞死分級的提高,其全身并發(fā)癥(5.9%、35.7%和60.0%)及腹部和傷口并發(fā)癥(6.1%、28.6%和60.0%)相應增加,同時死亡率增加(2.0%、14.3%和40.0%),各組之間均有顯著性差異(P0.05)。 結(jié)論 1.腸壞死分級能夠客觀反映腸壞死后腸管損傷的程度及其相應的患者預后,尤其是有合并癥的高齡、高ASA評分患者。 2.腸壞死分級能夠指導臨床及時干預治療并預測和提高預后；外科應盡早干預以避免腸壞死發(fā)生或壞死程度加重從而影響患者預后。 第三部分嵌頓疝腸壞死和預后影響因素與腸壞死指數(shù)的建立 研究背景及目的 目前關于導致嵌頓疝腸壞死的因素以及影響嵌頓疝患者預后因素的研究報道較少。毫無疑問,嵌頓時間的長短是導致(或影響)腸壞死的主要因素,而其他因素,如年齡、性別、合并癥、疝類型是否是影響腸壞死的因素結(jié)果差異較大。大部分研究表明腸壞死后腸切除是影響預后的主要因素,但其他因素,如年齡、有無合并癥、能否耐受手術等因素在預后中亦扮演重要角色,但各研究結(jié)果差異較大。再者嵌頓疝,尤其是合并腸壞死者應用補片修補是否可行爭議更大。 本研究的目的是在通過對嵌頓疝患者臨床資料回顧性分析,目的分析導致嵌頓疝患者腸壞死并腸切除的危險因素,以及影響嵌頓疝患者預后的因素,尤其是探討腸壞死和修補方式與患者預后的關系。同時依據(jù)引起腸壞死的因素和加重腸壞死的因素,建立腸壞死指數(shù)以客觀判斷腸壞死及其程度來指導臨床預測腸管絞窄發(fā)生和腸壞死程度分級,最終指導臨床預后判斷。研究方法 對2003年1月至2013年12月1168例急癥手術治療的成人嵌頓性腹股溝疝患者的臨床資料進行回顧性分析,采用單變量及多變量統(tǒng)計方法分析導致腸壞死并腸切除的危險因素以及影響嵌頓疝患者預后的因素,探討修補方式與預后的關系。對于有意義的導致腸壞死的因素,結(jié)合第二部分研究結(jié)果中影響腸壞死程度的因素,作為危險因素賦分并制定腸壞死指數(shù),劃定賦分范圍確定腸壞死的有無及壞死程度分級。 結(jié)果 1.所有患者均急癥手術并疝修補,共有1147例患者納入本研究,其中195例(17%)患者因腸壞死而行腸切除,952例(83%)無腸壞死患者。術后并發(fā)癥及死亡率分別為16.9%和5.1%。 2.腸壞死患者和非腸壞死患者兩組在年齡、性別、有無伴隨疾病、疝類型、嵌頓時間、有無腸梗阻及腹膜炎等各因素之間均有顯著性差別(P0.05)。Logistic回歸多因素分析顯示,嵌頓時間≥6h(OR=8.32, P0.001)、股疝(OR=10.47, P=0.018)和腹膜炎(OR=4.79,P=0.005)是導致腸壞死并腸切除的獨立危險因素。 3.嵌頓疝腸壞死指數(shù)5-10分無腸壞死,11～18分Ⅰ級腸壞死,19～26分Ⅱ級腸壞死,26分Ⅲ級腸壞死。 4.單變量分析顯示伴隨疾病、ASA評分、麻醉類型、修補方式和腸壞死與患者并發(fā)癥有關(P0.05)；而年齡、伴隨疾病、ASA評分和腸壞死與患者病死率有關(P0.05)。但Logistic回歸顯示只有腸壞死是影響預后(并發(fā)癥和病死率)的獨立危險因素(P0.01)。 5.嵌頓疝并腸壞死患者補片修補的總體并發(fā)癥大于一期縫合修補患者(P0.05),但對于Ⅰ級壞死患者應用補片修補的傷口感染率與一期縫合沒有差別(P0.05),多變量分析顯示補片的應用不是影響預后的危險因素(p0.05)。 結(jié)論 1.嵌頓時間大于6h、疝類型為股疝和腹膜炎是嵌頓疝腸壞死并腸切除的獨立危險因素,而腸壞死后腸切除是影響嵌頓疝患者預后的獨立因素。 2.嵌頓疝腸壞死指數(shù)的建立能夠指導臨床客觀評判腸壞死的有無以及預測腸壞死的分級,結(jié)合腸壞死分級更能提前預測和提高預后。 3.補片的應用能增加術后總體并發(fā)癥的發(fā)生,尤其是Ⅱ、Ⅲ級壞死患者傷口并發(fā)癥的發(fā)生,但不是影響預后的獨立因素。 第四部分腹股溝嵌頓疝并腸壞死的一期無張力疝修補 研究背景及目的 嵌頓疝并發(fā)腸壞死能否一期無張力疝修補有爭議。傳統(tǒng)的觀點認為行腸切除后創(chuàng)面污染,容易導致切口感染從而導致修補失敗而最終不得不取出補片。也有入認為嵌頓疝絞窄后腸管雖然已壞死,但如尚未發(fā)生穿孔,手術區(qū)域也未受到明確或明顯的污染,使用補片修補是可行的。也有研究發(fā)現(xiàn)切口的感染與是否應用補片無關。 對于擇期無張力疝修補,創(chuàng)面屬于清潔傷口,手術可行毋庸置疑。對于并發(fā)腸壞死患者,雖然臨床上有許多一期無張力疝修補的成功報告,但不是所有的腸管壞死后一期無張力疝修補是可行的。因為隨著壞死時間的延長,創(chuàng)面由污染到感染過渡。早期壞死創(chuàng)面屬于污染或潛在污染傷口,而后期可以明顯的壞死化膿,創(chuàng)面屬于明確污染或感染傷口,顯然不能修補。此條件下勉強修補只能導致手術失敗。 根據(jù)創(chuàng)面的污染情況來決定是否應用補片修補是首先考慮的,但患者的一般狀況在決定手術的成功與否中亦非常關鍵。而術中如何避免或減少污染及術后的綜合治療在手術的成功中亦扮演重要角色。 在之前的研究中我們通過動物實驗及臨床觀察首次對腸壞死程度進行分級,并且研究表明腸壞死程度與患者年齡及伴隨疾病以及ASA評分有關,并影響患者預后,且證實腸壞死是影響預后的獨立因素。同時研究表明對于Ⅰ級壞死患者,補片的應用沒有增加傷口等并發(fā)癥發(fā)生。本研究的目的為探索不同壞死分級下結(jié)合患者一般狀況行一期無張力疝修補的可行性,總結(jié)一期無張力疝修補的成功經(jīng)驗。研究方法 對2005年1月至2013年6月40例腹股溝嵌頓疝并發(fā)腸壞死患者,依據(jù)腸壞死分級標準對腸壞死程度進行分級,對其中一般狀況較好(ASAⅠ、Ⅱ)的21例Ⅰ級壞死、4例Ⅱ級壞死患者根據(jù)個體化原則的綜合治療下行腸切除吻合并一期無張力疝修補,對其余一般狀況較差(ASAⅢ、Ⅳ)或(和)壞死程度較重的7例Ⅰ級壞死、5例Ⅱ級壞死和3例Ⅲ級壞死患者行單純縫合修補。記錄術后并發(fā)癥并分析壞死等級與ASA評分和術后并發(fā)癥的關系。 結(jié)果 選擇性25例一期無張力疝修補患者沒有死亡病例,其余患者死亡4例。全部患者術后血腫5例；切口感染8例,其中Ⅰ級壞死補片修補患者1例,為皮下感染,經(jīng)換藥未除去網(wǎng)片痊愈,Ⅱ級壞死患者4例,其中補片修補2例,1例因深部組織感染(合并補片感染)而不得不取出補片。術后隨訪6月以上補片修補患者無排異反應發(fā)生。術后復發(fā)4例,其中1例為Ⅱ級壞死感染后取出補片患者。統(tǒng)計分析示腸壞死分級與ASA評分相關(r=0.388,P=0.018),隨者壞死程度加重和ASA評分增加,術后并發(fā)癥逐步增加(P0.05)。 結(jié)論 1.對于腸壞死程度Ⅰ級、ASA評分Ⅰ、Ⅱ的患者,一期無張力疝修補可以取得成功,是可行的。 2.正確評價腸壞死的程度,結(jié)合患者的一般狀況來選擇性一期無張力疝修補是嵌頓疝并發(fā)腸壞死手術的合理選擇。
[Abstract]:Part I establishment of incarcerated hernia animal model and systematic evaluation of intestinal necrosis degree
Background and purpose of research
Intestinal necrosis may be shown as an early non specific symptom and late delayed specific symptoms. Intestinal ischemic disease caused by various causes in the clinic can cause intestinal necrosis, and incarcerated hernia is one of the common causes of intestinal ischemia. If incarcerated incarcerated in time, it can lead to intestinal strangulation and necrosis, eventually leading to local and systemic severity. Clinical consequences.
As far as the degree of intestinal necrosis is evaluated, the bowel wall can be transferred from the mucosa, the myometrium to the permeable full layer infarction, but as the human system, the intestinal necrosis caused by incarcerated hernia can lead to local inflammation (swelling, even cellulitis, even cellulitis, intestinal fistula), intestinal obstruction, peritonitis, infectious shock and other parts. The reason is that the extent of intestinal necrosis is different with the prolongation of necrotic time, and the clinical consequences are different, and the methods and prognosis are different at the same time.
There is no rapid and reliable indicator to predict intestinal ischemia and to determine the time of intestinal necrosis. There is no system to judge the extent of intestinal necrosis in the clinic, because the intestinal necrosis caused by incarcerated hernia is different from other causes of intestinal necrosis and is more suitable for establishing one. The purpose of this study is to establish a rat model of incarcerated hernia of abdominal wall, to simulate the process of intestinal strangulation and to observe the local and systemic manifestations of intestinal necrosis and to provide an experimental basis for the establishment of the classification of incarcerated hernia intestinal necrosis.
An animal model of incarcerated hernia of abdominal wall was made in adult healthy male Wistar rats. According to the increase of incarceration time, the model was divided into 12 groups, and the incarceration time was from 2H, respectively, in 2H, 4h, 6h, 8h, 12h, 16h, 20h, 24h, 28h, 32H, as a time node, and the morphological and histological observation of necrotic intestines in different time nodes. The degree of intestinal necrosis was systematically assessed by local inflammation and systemic performance, and the difference of intestinal necrosis between the control group and the control group was compared.
Result
1. intestinal canal injury in the time of incarceration 4-6h to realize full layer necrosis of histology, abdomen can appear intestinal obstruction signs. Incarcerated time 16h, intestinal tube can break, local inflammation and examination of bacteria, abdomen can have peritonitis appearance. Incarceration time more than the 32H incarcerated intestinal tube form disappeared, local cellulitis, to 72h rats gradually shock death.
2. compared with the control group, the score of the intestinal necrosis system in each experimental group was increased according to the incarceration time, and the time of incarceration was more than 36h until the rat died, and the system score was the highest. There was a significant difference in the system score between the experimental groups, the difference in the system score of incarcerated time of 8h and above, and the system score between the group of incarcerated 4-6h and the group 16-20h, the scores of the system among the 32-36h groups were Significant differences, P values are less than 0.05.
conclusion
1. the rats' abdominal wall incarcerated hernia model prepared by this experiment is a good simulation of the process of intestinal strangulation to necrosis, and the clinical manifestation and final outcome in the process are presented.
2. with the prolongation of the incarceration time, the score of the intestinal necrosis system showed a more obvious time correlation. The score of the intestinal necrosis system could objectively reflect the progression of the incarcerated hernia intestinal necrosis.
The second part is about the relationship between the clinical grading of incarcerated hernia and the clinical characteristics of patients.
Incarcerated hernia in the clinic requires urgent surgical intervention, but the complications and mortality of the operation are increased in non elective cases. As a common surgical emergency after inguinal hernia incarceration, it can significantly increase the risk of intestinal obstruction and intestinal strangulation. About 15% of the inguinal incarcerated hernia can develop intestinal necrosis and have to be excised. The rate is up to 5%.
Although the final outcome of the incarcerated hernia is intestinal necrosis, the local and systemic symptoms and signs are different with the prolongation of the necrotic time. In the early stages of the necrosis, the strangulated intestine has been partially or completely necrotic, but has not yet been perforated, and the surgical area and abdominal cavity have not been clearly or obviously polluted, but the local and systemic symptoms are lighter. It is in the late stage of necrosis that the bowel can disappear or perforate the shape of the intestine, and the local may be phcellulitis. The wound belongs to the clear pollution or infection of the wound; the abdomen can be manifested by intestinal obstruction and peritonitis; the whole body can be characterized by septic shock and even death. As a system, the degree of incarcerated hernia bowel necrosis is different, corresponding clinical outcome and However, there is no systematic definition of the degree of intestinal necrosis.
In the previous study, we conducted a preliminary observation and systematic evaluation of the progression of incarcerated hernia and intestinal necrosis in the abdominal wall of rats. This study was to establish a classification of intestinal necrosis by clinical observation of intestinal morphology, local and systemic symptoms and signs in patients with inguinal incarcerated hernia complicated with intestinal necrosis. The objective of the system is to objectively reflect the degree of intestinal necrosis, and to analyze the relationship between the grading of intestinal necrosis and the clinical characteristics of patients, especially the relationship with the prognosis of patients.
A prospective and exclusionary study of all acute adult incarcerated hernia patients during the period from January 2003 to January 2013 was conducted to observe the local and systemic manifestations of patients with inguinal incarcerated hernia complicated with enteronecrosis, according to the incarceration time, the shape of the necrotic intestine and the integrity of the hernia sac. The degree of intestinal necrosis and the relationship between the classification of intestinal necrosis and the relationship between the classification of intestinal necrosis and the prognosis of the patients were analyzed.
1. a total of 68 patients were included in this study and the 3 grade intestinal necrosis classification system was established. There were 49 (72.1%) class I necrosis patients, 14 (20.1%) class II necrosis patients and 5 (7.4%) stage III necrosis patients. The postoperative complications and mortality were 32.4% and 7.4%., respectively.
2. age over 65 years (P=0.035), accompanied by disease (P=0.008) and high ASA score (P=0.014) were the factors that aggravated intestinal necrosis and affected the grading of intestinal necrosis.
3. with the improvement of intestinal necrosis, its systemic complications (5.9%, 35.7% and 60%) and abdominal and wound complications (6.1%, 28.6% and 60%) increased correspondingly, and the mortality increased (2%, 14.3% and 40%), and there were significant differences between each group (P0.05).
conclusion
1. the grading of intestinal necrosis can objectively reflect the degree of intestinal injury after intestinal necrosis and the prognosis of the patients, especially in the elderly with high complication and ASA score.
2. intestinal necrosis classification can guide the clinical intervention and predict and improve the prognosis in time. Surgery should intervene early to avoid the severity of necrosis or necrosis of intestinal necrosis and affect the prognosis of the patients.
The third part is incarcerated hernia intestinal necrosis and prognostic factors and establishment of intestinal necrosis index.
Background and purpose of research
There are few reports on the factors that lead to incarcerated hernia and the factors affecting the prognosis of incarcerated hernia. There is no doubt that the length of incarceration time is the main factor leading to (or affecting) intestinal necrosis. Other factors, such as age, sex, complication, and type of hernia are the major factors that affect intestinal necrosis. Studies have shown that enterecrosis after intestinal necrosis is a major prognostic factor, but other factors, such as age, absence of complications, and tolerance to surgery also play an important role in prognosis, but the results vary greatly.
The purpose of this study was to review the clinical data of patients with incarcerated hernia and to analyze the risk factors leading to intestinal necrosis and intestinal resection in patients with incarcerated hernia, as well as factors affecting the prognosis of patients with incarcerated hernia, especially to explore the relationship between intestinal necrosis and repair methods and the prognosis of patients. The factor of intestinal necrosis, the establishment of the intestinal necrosis index to objectively judge the intestinal necrosis and its degree to guide the clinical prediction of intestinal strangulation and the degree of intestinal necrosis, and ultimately guide the clinical prognosis.
The clinical data of 1168 cases of adult incarcerated inguinal hernia treated by emergency surgery from January 2003 to December 2013 were retrospectively analyzed. A single variable and multivariate statistical method was used to analyze the risk factors leading to intestinal necrosis and intestinal resection, as well as the factors affecting the prognosis of incarcerated hernia patients, and the relationship between the repair mode and the prognosis was discussed. Factors contributing to intestinal necrosis, combined with the factors that affect the degree of intestinal necrosis in the second part of the study, are assigned as risk factors, and the intestinal necrosis index is established, and the classification of the extent of the necrosis of intestinal necrosis is defined to determine the extent of the necrosis of the intestinal necrosis.
Result
1. all patients underwent emergency surgery and herniorrhaphy. A total of 1147 patients were included in this study, of which 195 cases (17%) underwent enteronecrosis with intestinal necrosis and 952 (83%) patients with no intestinal necrosis. The postoperative complications and mortality were 16.9% and 5.1%., respectively.
There were significant differences in age, sex, unaccompanied disease, type of hernia, incarceration, intestinal obstruction and peritonitis between the two groups of 2. enteronecrosis patients and non enteronecrosis patients (P0.05).Logistic regression multivariate analysis showed that the incarceration time was more than 6h (OR= 8.32, P0.001), OR=10.47, P=0.018, and peritonitis (OR=4.79, P=0.0) 05) is an independent risk factor for intestinal necrosis and bowel resection.
3. the incarcerated hernia had an intestinal necrosis index of 5-10 points without intestinal necrosis, 11~18 grade I intestinal necrosis, 19~26 grade II intestinal necrosis, and 26 grade III intestinal necrosis.
4. univariate analysis showed that the associated disease, ASA score, type of anesthesia, patching and intestinal necrosis were associated with patient complications (P0.05); age, associated disease, ASA score, and intestinal necrosis were associated with patient mortality (P0.05). But Logistic regression showed that only intestinal necrosis was an independent risk factor for prognosis (complications and mortality) (P0.01).
The total complication of patch repair in patients with 5. incarcerated hernia and intestinal necrosis was greater than that of one stage suture repair (P0.05), but there was no difference between the wound infection rate of patch repair and primary suture in patients with stage I necrosis (P0.05). Multivariate analysis showed that the application of patch was not a risk factor for prognosis (P0.05).
conclusion
1. incarceration time is greater than 6h, hernia type and peritonitis are independent risk factors for incarcerated hernia intestinal necrosis and intestinal resection, and intestinal resection is an independent factor affecting the prognosis of patients with incarcerated hernia.
The establishment of 2. incarcerated hernia intestinal necrosis index can guide the clinical evaluation of intestinal necrosis or predict the classification of intestinal necrosis. Combined with the classification of intestinal necrosis, the prognosis can be predicted and improved in advance.
The application of 3. patch can increase the incidence of postoperative complications, especially the occurrence of wound complications in patients with grade II and III necrosis, but it is not an independent prognostic factor.
The fourth part of inguinal incarcerated hernia with intestinal necrosis one stage tension free hernia repair.
Background and purpose of research
It is controversial whether incarcerated hernia and enteronecrosis are tension-free herniorrhaphy. Patch repair is feasible for definite or apparent contamination. Studies have also found that infection of incisions is not related to patch application.
For selected tension-free herniorrhaphy, the wound is a clean wound, and the operation is unquestionable. For patients with complicated intestinal necrosis, although there are many successful reports of tension free herniorrhaphy in the clinic, it is not all tension free hernia repair after necrosis of the intestine. As the time of necrosis is prolonged, the wound is contaminated to the sense of the wound. The early necrotic wound is contaminated or submersible
【學位授予單位】：山東大學
【學位級別】：博士
【學位授予年份】：2014
【分類號】：R656.2

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本文編號：1908652