持续性非卧床腹膜透析病人并发腹股沟疝的外科治疗

doi:10.16139/j.1007-9610.2021.05.013

摘要/Abstract

摘要：

目的：探讨安全有效地治疗持续性非卧床腹膜透析病人并发腹股沟疝的外科治疗方案。方法：回顾性分析2013年至2019年我院收治41例病人43侧腹股沟疝的临床资料、诊疗经过和随访结果。结果：同期收治的792例腹膜透析病人中,腹股沟疝的发病率为5.2%（41/792）,平均年龄（62.1±10.7）岁,体质量指数（21.6±4.9） kg/m²。原发疾病中慢性肾小球肾炎23例（56.1%）,糖尿病肾病10例（24.4%）,高血压性肾硬化4例（9.7%）。确诊前透析时间（17.3±14.9）个月。单侧疝39例,双侧疝2例。中华医学会疝和腹壁外科学组腹股沟疝分型（2003版）Ⅰ型11侧,Ⅱ型30侧,Ⅲ型2侧。疝环直径（2.6±0.9） cm。41例均手术成功,41侧行轻型平补片无张力Lichtenstein手术,2侧行腹膜前UHS超普疝补片修补手术。平均手术时间（46.7±17.3） min。手术并发症发生率19.5%,其中血清肿3例,阴囊水肿2例,切口出血、感染和慢性疼痛各1例。39例采用自动化腹膜透析14~33 d,2例采用临时中心静脉插管血液透析作为术后过渡性透析治疗。随访期（29.7±15.7）（2~65）个月,无疝复发。结论：轻型补片开放无张力Lichtenstein手术疗效明确,并发症轻微,为持续性非卧床腹膜透析病人并发腹股沟疝的首选术式。自动化腹膜透析为过渡性透析治疗的首选方式。

关键词: 持续性非卧床腹膜透析, 腹股沟疝, 疝修补术, 自动化腹膜透析

Abstract: Objective To explore the safe and effective surgical treatment for inguinal hernia in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods The clinical data including treatment and follow-up of 41 patients with 43 sides treated in our hospital from January 2013 to December 2019 were analyzed retrospectively. Results The incidence of inguinal hernia in 792 peritoneal dialysis (PD) patients was 5.2% (41/792). Average age was (62.1±10.7) years old and body mass index (BMI) was (21.6±4.9) kg/m². There were 23 cases with primary diseases chronic glomerulonephritis (56.1%), 10 cases diabetic nephropathy (24.4%) and 4 cases hypertensive renal sclerosis (9.7%). The period of dialysis was (17.3±14.9) months before diagnosis. Thirty-nine cases were unilateral hernia and 2 cases were bilateral hernia. Eleven sides were Chinese classification type Ⅰ hernia, 30 sides type Ⅱ and 2 sides type Ⅲ. The diameter of hernia ring was (2.6±0.9) cm. All patients underwent successful tension-free mesh repair, including 41 sides with Lichtenstein and 2 sides with anterior UHS procedures. The average operative time was (46.7±17.3) min. There was complication rate of 19.5% including 3 cases seroma and 2 cases scrotal edema. Surgical site bleeding, infection and chronic pain were one case each. Automated peritoneal dialysis (APD) was given 39 cases (14-33) d and temporary central venous catheterization hemodialysis 2 cases as postoperative transitional dialysis. No recurrence of hernia occurred during the period of follow-up (29.7±15.7) (2-65) months. Conclusions Open tension-free Lichtenstein procedure with light flat mesh has satisfactory effect and is preferred choice for the treatment of inguinal hernia in CAPD patients. APD could be first choice for transitional dialysis.

Key words: Continuous ambulatory peritoneal dialysis, Inguinal hernia, Hernioplasty, Automated peritoneal dialysis

中图分类号:

R656.21

陈涛, 徐煜, 付学良, 袁志青, 花荣. 持续性非卧床腹膜透析病人并发腹股沟疝的外科治疗[J]. 外科理论与实践, 2021, 26(05): 425-429.

CHEN Tao, XU Yu, FU Xueliang, YUAN Zhiqing, HUA Rong. Surgical treatment for inguinal hernia in continuous ambulatory peritoneal dialysis patients[J]. Journal of Surgery Concepts & Practice, 2021, 26(05): 425-429.

图/表 2

参考文献 20

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临床资料	数据
病例数/疝例数	41/43
性别(男/女)	34/7
年龄(岁)	62.1±10.7
BMI(kg/m²)	21.6±4.9
确诊疝前PD时间(月)	(17.3±14.9)(0~47)
确诊疝前PD剂量(L)	7.3±1.2
肾脏原发疾病[n(%)]
慢性肾小球肾炎	23(56.1)
糖尿病肾病	10(24.4)
高血压性肾硬化	4(9.7)
狼疮性肾病	2(4.9)
多囊肾	2(4.9)
合并症[n(%)]
高血压	33(80.5)
糖尿病	18(43.9)
心脑血管疾病	17(41.5)
贫血	15(36.6)

手术相关资料	数据	P值
疝例数(n)
疝位置(左/右/双侧)	14/25/2	-
疝类型(斜疝/直疝)^a)	31/12	-
疝分型(n)^a)
疝分型(Ⅰ/Ⅱ/Ⅲ)	11/30/2	-
疝环直径(cm)	2.6±0.9	-
麻醉方式(n)
局麻/神经阻滞/全麻	35/4/2	-
手术方式(n)^a)
Lichtenstein手术/UHS手术	41/2	-
手术时间(min)	(46.7±17.3)(36~98)	-
术后过渡期透析方式(n)
HD/自动化PD	2/39	-
主要实验室指标(术前/术后)^b)
血肌酐(μmol/L)	821.9±316.2 / 840.5±292.3	0.71
血钾(μmol/L)	4.0±0.5 / 4.2±0.5	0.51
血pH	7.38±0.03 / 7.35±0.05	0.66
血红蛋白(g/L)	111.8±20.3 / 105.6±18.2	0.58
血清白蛋白(g/L)	36.6±5.1 / 34.6±4.2	0.47
术后随访时间(月)	(29.7±15.7)(2~65)	-