嵌顿性腹股沟疝并肠坏死行肠切除并一期无张力疝修补可行性探析

目的 对嵌顿性腹股沟疝并发肠坏死的坏死程度分级,探讨不同坏死分级下行一期无张力疝修补的可行性.方法 对35例嵌顿性腹股沟疝并发肠管坏死患者,依据嵌顿时间、肠管形态、疝囊及周围组织炎性程度以及有无腹膜炎体征对肠坏死程度进行分级,对22例1级坏死患者,4例2级坏死患者根据个体化原则的综合治疗下行肠切除吻合并一期无张力疝修补.结果 选择性26例一期无张力疝修补患者没有死亡病例.术后阴囊血肿2例,切口感染3例,其中1级患者1例,2级患者2例,经换药未除去网片痊愈.术后随访6个月以上,无排异反应发生,复发1例.结论 正确评价坏死的程度,结合患者的耐受情况,个体化原则的综合治疗是嵌顿疝肠坏死切除一期无张力疝修补成功的关键.

Feasibility of simultaneous bowel resection and primary tension-free herniaplasty in incarcerated inguinal hernia with necrosis of intestines

Objective To grade the intestine necrosis in incarerated inguinal hernia and explore the feasibility of primary tension-free herniaplasty.Methods Of 35 patients with incarcerated inguinal hernia and intestine necrosis,the extents of necrosis were graded according to time of incarceration,morphology of intestines,the hernia sac and the surrounding inflammatory levels and presence of peritonitis signs of intestinal necrosis.Twenty-two cases with Grade 1 necrosis,four cases with Grade 2 necrosis performed bowel resection and primary tension-free herniaplasty under the individualized principles.Results There was no death in 26 patients with selective primary tension-free herniaplasty.Two cases of post-operation scrotum hematoma,3 cases of incision infection(one is Grade 1 and two are Grade 2) were included.They were recovered with dressing change and no patch was removed.After 6-month follow-ups,there was no rejection reaction and only one case recurred.Conclusions With appropriate assessments for the degree of necrosis and combined with individual situation,individualized treatment is the key for simultaneous bowel resection and primary tension-free herniaplasty in the patients with incarerated inguinal hernia and intestines necrosis.