腹腔镜腹股沟疝修补术后血清肿的相关危险因素分析

目的:探讨腹腔镜腹股沟疝修补术后血清肿的相关危险因素,为临床治疗、有效预防及减少术后血清肿提供必要依据。方法:收集2017年6月至2018年5月行腹腔镜腹股沟疝修补术的189例患者的临床资料,包括性别、BMI、疝类型(斜疝、直疝、股疝)、疝一般情况(疝囊大小、双侧疝、阴囊疝、难复性疝、嵌顿疝)、手术时间、手术方式、补片、疝囊处理方式、补片固定方式及血清肿等,建立数据库。采用SPSS 23.0软件进行单因素(χ2检验及对数似然比检验)与多因素分析(Logistic回归分析),寻找引起术后血清肿的相关因素。结果:单因素分析显示,直疝(P=0.011)、胶水固定补片(P=0.006)与腹腔镜腹股沟疝修补术后血清肿相关。多因素分析显示,直疝(OR值1.873,95%可信区间1.038~3.380)、胶水固定补片(OR值为1.514,95%可信区间1.019~2.251)是腹腔镜腹股沟疝修补术后血清肿发生的独立危险因素。结论:直疝及胶水固定补片是腹腔镜腹股沟疝修补术后血清肿发生的独立危险因素,为减少术后血清肿的发生,推荐减少胶水固定补片,消灭直疝假性疝囊形成的残腔。

Multivariate analysis of related risk factors of postoperative seroma of laparoscopic inguinal hernia repair

Objective:To identify the predictive risk factors related to postoperative seroma in patients undergoing laparoscopic inguinal hernia repair,and to provide the necessary basis for the prevention and minimization of postoperative seroma.Methods:Data of 189 patients,who received laparoscopic inguinal hernia repair from Jun.2017 to May 2018,were enrolled in this study.Information about the patients was collected from the case files to set up the data base where the clinical factors,such as gender,BMI,types of hernia(indirect hernia,direct hernia,femoral hernia),general characteristics of hernia(size of hernia sac,bilateral hernia,scrotal hernia,irreducible hernia,incarcerated hernia),operative time,operative method,mesh,management of hernia sac,mesh fixation and seroma were retrieved for analysis.SPSS 23.0 software was used for univariate(chi-square test and log-likelihood ratio test)and multivariate logistic regression analysis,in order to find the relevant risk factors of postoperative seroma.Results:Univariate analysis showed that direct hernia(P=0.011)and mesh fixation by glue(P=0.006)were related with postoperative seroma of laparoscopic inguinal hernia repair.Multivariate analysis indicated that direct herniaodds ratio(OR):1.873,95%confidence interval(CI)1.038~3.380]and the mesh fixation by glue(OR:1.514,95%CI:1.019~2.251)were the independent risk factors which might affect the occurrence of seroma after the surgery.Conclusions:Direct hernia and mesh fixation by glue are the independent risk factors of the seroma after laparoscopic inguinal hernia repair.In order to reduce the incidence of postoperative seroma,it is recommended to reduce mesh fixation by glue and eliminate the residual cavity formed by the pseudo hernia sac of direct hernia.