腹内疝与腹部手术史的相关性分析

目的通过对腹内疝发生与腹部手术史相关性的分析，增加外科医师对不同类型腹内疝发病特点的认识，改善手术治疗效果。 方法回顾性分析2011年1月至2016年12月，苏州大学附属第一医院收治的36例腹内疝患者的病例资料，比较腹部手术史与腹内疝患者病程时间、发病前是否存在胃肠功能紊乱、术前诊断、发生肠绞窄坏死、肠管疝入途径、手术时间、术后并发症发生率、术后死亡率的相关性。 结果腹内疝患者病程时间、发病前是否存在胃肠功能紊乱、术前诊断、发生肠绞窄坏死、肠管疝入途径、术后并发症发生率在有无腹部手术史的2组人群中比较，差异无统计学意义（P>0.05）。无腹部手术史组的平均手术时间，多于有腹部手术组的平均手术时间，差异有统计学意义（χ²=6.236，P=0.013）；无腹部手术史组的11例患者中，有2例死亡病例，死亡率要高于有腹部手术史组，差异有统计学意义（χ²=4.67，P=0.031）。 结论有无腹部手术史对腹内疝的发病过程及术后并发症的发生并无影响，但无腹部手术史组的腹内疝患者，其手术时间及术后死亡率要高于有腹部手术史组，这可能与无腹部手术史组在病程早期即可出现肠绞窄坏死有关。大部分的腹内疝患者在早期表现为不明原因的肠梗阻，对于肠梗阻不能缓解或反复发作者，及时剖腹探查，有助于提高治疗效果，减少术后死亡率。

Analysis of diagnosis and treatment of internal hernia and its correlation with past abdominal surgery

ObjectiveTo increase the understanding of the characteristics in different types of internal hernia, and improve the effect of surgical treatment. MethodsWe retrospectively analyzed 36 cases of internal hernia in The First Affiliated Hospital of Soochow University from January 2011 to December 2016. The clinical data of onset, diagnosis and surgical treatment process were reviewed and analyzed for each case, including past abdominal operation, duration time of internal hernia, gastrointestinal dysfunction before onset, preoperative diagnosis, intestinal necrosis, pathway of internal hernia, operation time, postoperative complications and postoperative mortality. ResultsPatients were divided into two groups, according to the condition that whether or not they had past abdominal operation. There was no significant statistical difference between the two groups in duration time of internal hernia, gastrointestinal dysfunction before onset, preoperative diagnosis, intestinal necrosis, pathway of internal hernia, and postoperative complications. However, there was a significant statistical difference between the two groups in operation time and postoperative mortality. The average operation time was significant more in no past abdominal operation group than in with past abdominal operation group (χ²=6.236, P=0.013); and the postoperative was significant higher in no past abdominal operation group (18.2%) than in with past abdominal operation group (χ²=4.67, P=0.031). ConclusionPast abdominal operation had no effect on the disease process and postoperative complications of internal hernia. However, the operation time and postoperative mortality were higher in no past abdominal operation group than in with past abdominal operation group. This may related to that the intestinal strangulation necrosis occurred at an early stage in internal hernia patients of no past abdominal operation group. Most of the patients manifested as unexplained ileus in the early stage of internal hernia. Timely exploratory laparotomy can help to improve the treatment effectiveness and reduce the postoperative mortality for the internal hernia patients manifested as irrelievable or recurrent intestinal obstruction.