發(fā)布時(shí)間：2018-04-26 23:15

  本文選題：腹外疝 + 無張力修補(bǔ)術(shù)��； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：背景:腹外疝屬于普外科的常見病及多發(fā)病之一,以腹股溝疝發(fā)病率最高,占腹外疝的90%-95%,此外,股疝、切口疝、臍疝等也是臨床上較常見的腹外疝。腹外疝發(fā)生后,多無法自行愈合,手術(shù)是治療腹外疝最有效的措施。但傳統(tǒng)疝修補(bǔ)術(shù)縫合張力大,術(shù)后疼痛明顯,且復(fù)發(fā)率高。自無張力修補(bǔ)術(shù)的概念提出后,腹外疝的預(yù)后獲得明顯改善,合成補(bǔ)片在臨床上的應(yīng)用也越來越廣泛。然而由合成補(bǔ)片所帶來的并發(fā)癥(如補(bǔ)片感染、血清腫、腸粘連等)卻成為臨床上新的難題。補(bǔ)片感染的發(fā)生常常導(dǎo)致修補(bǔ)手術(shù)的失敗,其治療也較困難,是腹外疝修補(bǔ)術(shù)后嚴(yán)重并發(fā)癥之一。但目前有關(guān)補(bǔ)片感染的病因、危險(xiǎn)因素及預(yù)防措施仍缺乏足夠的認(rèn)識(shí),對(duì)于補(bǔ)片感染的治療也缺乏統(tǒng)一的標(biāo)準(zhǔn)。目的:分析腹外疝修補(bǔ)術(shù)后補(bǔ)片感染患者的臨床資料,復(fù)習(xí)相關(guān)文獻(xiàn)綜述,對(duì)其危險(xiǎn)因素、臨床表現(xiàn)及診療過程進(jìn)行總結(jié),為補(bǔ)片感染的防治提供臨床經(jīng)驗(yàn)。方法:回顧性分析自2013年11月至2017年3月期間山東大學(xué)齊魯醫(yī)院收治的13例腹外疝修補(bǔ)術(shù)后補(bǔ)片感染的病例,對(duì)患者的臨床資料,包括患者基本信息、病史資料、實(shí)驗(yàn)室檢查、診療過程、隨訪情況等進(jìn)行整理分析。結(jié)果:本研究13例患者中,男性10例,女性3例,男女比例為3.3:1。年齡分布為20-68歲,平均年齡為46.5±15.2歲,平均體重指數(shù)為26.1±4.4kg/m2。腹股溝疝9例,切口疝4例�；颊吲R床表現(xiàn)中,發(fā)熱2例,局部紅腫1例,疼痛6例,竇道形成并膿性分泌物12例�；颊叩牟〕虝r(shí)間為41天至2年不等,中位時(shí)間為6個(gè)月(四分位間距為3.5至18個(gè)月)。13例患者經(jīng)41天至2年不等的保守治療均未獲得治愈,而采取手術(shù)治療。術(shù)后1例患者出現(xiàn)切口感染,經(jīng)保守治療獲得痊愈。13例患者均經(jīng)手術(shù)治療獲得治愈,隨訪時(shí)間4-36個(gè)月,中位時(shí)間12個(gè)月(四分位間距8.5至27.5個(gè)月),無復(fù)發(fā)病例。結(jié)論:1.患者自身因素、開放手術(shù)、急診手術(shù)和手術(shù)切口感染可能會(huì)增加腹外疝修補(bǔ)術(shù)后補(bǔ)片感染發(fā)生的風(fēng)險(xiǎn)。2.補(bǔ)片感染多呈慢性病程,可表現(xiàn)為疼痛、局部紅腫、竇道形成、膿性分泌物等局部癥狀,也可伴有發(fā)熱等全身癥狀。3.補(bǔ)片感染的診斷主要依靠患者的病史及臨床表現(xiàn),實(shí)驗(yàn)室檢查及超聲、CT等影像學(xué)檢查可輔助診斷。4.補(bǔ)片感染的治療應(yīng)遵循個(gè)體化原則,當(dāng)長(zhǎng)時(shí)間保守治療不能獲得痊愈時(shí),應(yīng)及時(shí)經(jīng)手術(shù)移除感染補(bǔ)片。
[Abstract]:Background: external abdominal hernia is one of the most common diseases in general surgery. The incidence of inguinal hernia is the highest, accounting for 90-95% of external abdominal hernia. In addition, femoral hernia, incisional hernia, umbilical hernia and so on are also more common in clinic. Most of the external hernia can not heal by itself. Surgery is the most effective measure to treat the external hernia. But the traditional herniorrhaphy has great tension, obvious postoperative pain and high recurrence rate. Since the concept of tension-free repair was put forward, the prognosis of external abdominal hernia has been improved obviously, and the clinical application of composite patch has become more and more extensive. However, the complications (such as patch infection, serum swelling, intestinal adhesion, etc.) caused by synthetic patch have become a new clinical problem. The occurrence of patch infection often leads to the failure of repair operation, and its treatment is difficult, which is one of the serious complications after external abdominal hernia repair. However, the etiology, risk factors and preventive measures of patch infection are still lack of sufficient understanding, and there is also a lack of uniform standards for the treatment of patch infection. Objective: to analyze the clinical data, review the related literature, summarize the risk factors, clinical manifestations and diagnosis and treatment of the patients with the infection after repair of external abdominal hernia, so as to provide clinical experience for the prevention and treatment of the patch infection. Methods: from November 2013 to March 2017, 13 cases of external hernia repair were retrospectively analyzed in Qilu Hospital of Shandong University. The clinical data, including basic information, medical history and laboratory examination, were analyzed retrospectively. The diagnosis and treatment process and follow-up were analyzed. Results: of the 13 patients in this study, 10 were males and 3 females, with a ratio of 3.3: 1. The age distribution is 20-68 years old, the average age is 46.5 鹵15.2 years old, the average body mass index is 26.1 鹵4.4 kg / m2. Inguinal hernia 9 cases, incisional hernia 4 cases. There were 2 cases of fever, 1 case of local redness, 6 cases of pain, 12 cases of sinus formation and purulent secretion. The course of disease ranged from 41 days to 2 years, the median time was 6 months (quartile spacing was 3.5 to 18 months). 13 patients were not cured by conservative treatment ranging from 41 days to 2 years, but were treated surgically. Incision infection occurred in one patient after operation. All the 13 patients were cured by conservative treatment. The follow-up time was 4-36 months and the median time was 12 months (quartile interval 8.5 to 27.5 months). There were no recurrence cases. Conclusion 1. Patient factors, open surgery, emergency surgery, and surgical incision infection may increase the risk of patch infection after external herniorrhaphy. The infection of patch is mostly chronic disease, which can be shown as pain, local redness, sinus formation, purulent secretion and other local symptoms, but also accompanied by fever and other systemic symptoms. 3. The diagnosis of patch infection mainly depends on the patient's history and clinical manifestation. Laboratory examination and imaging examination such as ultrasound CT can assist the diagnosis. 4. The treatment of patch infection should follow the principle of individualization, and the infected patch should be removed in time when long time conservative treatment can not be cured.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R656.2

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本文編號(hào)：1808113