本文選題：無張力疝修補術(shù) + 隱匿性腸瘺�。� 參考：《延安大學》2016年碩士論文

【摘要】：背景:腹壁疝無張力修補術(shù)以其操作簡單,創(chuàng)傷小,恢復快,復發(fā)率低等優(yōu)點,在全世界得到廣泛應用。但隨著其應用例數(shù)的增加,如術(shù)后感染、慢性疼痛、血清腫、腸瘺等并發(fā)癥也時�？梢妶蟮�,而補片相關(guān)腸瘺是腹壁疝無張力修補術(shù)后最嚴重的并發(fā)癥。補片相關(guān)腸瘺的臨床表現(xiàn)主要為補片遲發(fā)性深部感染,一般通過竇道造影、腹部CT等影像學檢查可以確診,術(shù)中也可發(fā)現(xiàn)明顯腸瘺。但是隨著臨床病例的增多,我們發(fā)現(xiàn)還有一種特殊的補片相關(guān)腸瘺,這種腸瘺臨床上首先表現(xiàn)為補片遲發(fā)性感染,但是術(shù)前未發(fā)現(xiàn)有腸液溢出,竇道造影檢查也未見造影劑進入腸道,在手術(shù)去除感染補片中也未發(fā)現(xiàn)腸瘺癥狀,但在術(shù)后均出現(xiàn)較明顯的腸瘺癥狀。這種腸瘺的發(fā)生,因術(shù)前及術(shù)中沒有明顯的臨床表現(xiàn),我們可稱之為補片相關(guān)隱匿性腸瘺。目的:探討合成材料行腹壁疝無張力修補術(shù)后補片相關(guān)隱匿性腸瘺的發(fā)生原因、診斷、治療方法及預防。方法:收集陜西省人民醫(yī)院普外一科2003-2014年共36例腹壁疝無張力修補術(shù)后補片感染患者,其中5例去除感染補片術(shù)后發(fā)生補片相關(guān)隱匿性腸瘺病例,對補片相關(guān)隱匿性腸瘺的病因、診斷、治療及預防進行相關(guān)回顧性分析。結(jié)果:本組患者共5例,均在腹壁疝無張力修補術(shù)后發(fā)生補片感染,發(fā)生時間在術(shù)后3月-10年,這5例病例均在手術(shù)去除感染補片24-72h后引流管發(fā)現(xiàn)腸液,證明腸瘺發(fā)生,腸瘺量約為15-40 ml/d。發(fā)生腸瘺后5例病例均未手術(shù),在給予充分引流、抗感染、營養(yǎng)支持后痊愈,隨訪3月未見異常。結(jié)論:腹壁疝無張力修補術(shù)后發(fā)生補片相關(guān)隱匿性腸瘺,由于其初始臨床表現(xiàn)僅為補片遲發(fā)性深部感染,影像學檢查無法發(fā)現(xiàn),故而難以早期發(fā)現(xiàn),通過竇道引流液細菌培養(yǎng)結(jié)果為腸道內(nèi)菌群可以推測可能發(fā)生補片相關(guān)隱匿性腸瘺,確診還需術(shù)后引流管內(nèi)見到腸液。其發(fā)病原因可能與補片對腸管的侵蝕有關(guān),但也不能排除術(shù)中手術(shù)操作因素。對于其治療,保守治療為上,充分的引流是腸瘺愈合的必要條件。預防補片相關(guān)隱匿性腸瘺,主要從其病因預防,如何防止補片對腸管的侵蝕是預防的關(guān)鍵,此外去除感染補片術(shù)中仔細操作,避免損傷腸管也是應該引起注意的方面。
[Abstract]:Background: tension-free repair of abdominal hernia has been widely used in the world because of its advantages of simple operation, small trauma, quick recovery and low recurrence rate. But with the increase in the number of cases, such as postoperative infection, chronic pain, serum swelling, intestinal fistula and other complications are often reported, and patch related intestinal fistula is the most serious complication after tension-free repair of abdominal wall hernia. The main clinical manifestation of patch associated intestinal fistula was delayed deep infection, which could be diagnosed by sinus angiography, abdominal CT and other imaging examinations, and obvious intestinal fistula could also be found during the operation. But as the number of clinical cases increased, we found that there was also a special patch-associated intestinal fistula, which was the first clinical manifestation of late infection of the patch, but there was no intestinal overflow before the operation. No contrast agent was found in the intestinal tract on sinus angiography, and no intestinal fistula was found in the surgical decontamination patch, but there were obvious symptoms of intestinal fistula after operation. The occurrence of this kind of intestinal fistula, because there is no obvious clinical manifestation before and during operation, we can call it patch-related occult intestinal fistula. Objective: to investigate the causes, diagnosis, treatment and prevention of occult intestinal fistula after tension-free repair of abdominal wall hernia with synthetic materials. Methods: a total of 36 patients with abdominal wall hernia after tension-free repair were collected from 2003 to 2014 in the Department of General Department of the people's Hospital of Shaanxi Province. The etiology, diagnosis, treatment and prevention of patch-related occult intestinal fistula were analyzed retrospectively. Results: all of the 5 cases had patch infection after tension-free repair of abdominal wall hernia, the time of occurrence was from 3 months to 10 years after operation. The intestinal fluid was found in the drainage tube 24 to 72 hours after the removal of the infected patch, which proved the occurrence of intestinal fistula. The amount of intestinal fistula was about 15-40 ml / d. No operation was performed in 5 cases after enteric fistula. The patients were cured with adequate drainage, anti-infection and nutritional support. No abnormality was found in the follow-up of 3 months. Conclusion: after tension-free repair of abdominal wall hernia, there is an occult intestinal fistula associated with patch repair. Because its initial clinical manifestation is only delayed deep infection, it is difficult to find it by imaging examination. According to the results of bacterial culture in the drainage fluid of the sinus tract, it can be speculated that there may be a patch related occult intestinal fistula in the intestinal flora, and it is necessary to see intestinal fluid in the drainage tube after operation for the diagnosis of the disease. The cause of the disease may be related to the erosion of intestinal canal by patch, but the operative factors can not be excluded. For its treatment, conservative treatment, adequate drainage is a necessary condition for the healing of intestinal fistula. In order to prevent the occult intestinal fistula associated with patch, the main prevention is from its etiology. The key of prevention is how to prevent the patch from eroding the intestinal tube. In addition, the careful operation during the operation of removing the infection patch and avoiding the injury of the intestinal tube should also be paid attention to.
【學位授予單位】：延安大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R656.3

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