目的： 探讨高龄腹外嵌顿疝合并肠坏死的可能原因及治疗。方法： 回顾分析我科2013年1月至2017年12月收治的20例80岁以上腹外嵌顿疝合并肠坏死病人的临床资料。所有病人均行急诊手术治疗。术中证实为肠坏死并行肠切除吻合术,术中应用无张力疝修补术2例,传统Bassini修补术18例。常规在腹外斜肌腱膜下放置引流管。结果： 20例病人手术均顺利完成。2例分别术后第5、11天因肺部感染死亡。其余18例治愈出院。术后随访无复发,无补片感染等并发症发生。随访期间5例死亡。结论： 高龄病人嵌顿疝伴肠坏死的手术治疗总体成功。早期诊断及预防肺部感染具有积极作用。
Objective To investigate the cause and treatment of incarcerated hernia in elderly patients with intestinal necrosis. Methods A retrospective study was conducted using the data of 20 elderly patients more than 80 years old with incarcerated hernia combined with intestinal necrosis from January 2013 to December 2017 in our department. Emergency surgery was performed for all cases. Intestinal necrosis was diagnosed operatively and intestinal resection was performed combined with intestinal anastomosis. Two cases were processed with tension-free hernia repair and the other 18 cases were operated with Bassini repair. Drainage was placed under external abdominal oblique muscle fascia. Results The operation was completed successfully for all patients. Two patients died of pulmonary infection on postoperative 5 day and 11 day, respectively. The other patients were cured. During the period of postoperative follow-up, neither complication nor recurrence was found. Conclusions Surgical treatment could be considered as safe procedure for elderly patients with incarcerated hernia combined with intestinal necrosis. Early diagnosis and active prevention of pulmonary infection have positive effects on the prognosis of elderly patients.
[1] 李绍杰, 唐健雄, 胡星辰, 等. 嵌顿性腹股沟疝65例临床分析[J]. 中国实用外科杂志,2015,35(11):1223-1225.
[2] 吴天山, 郭飞. 无张力修补术在嵌顿疝引起的急腹症中的应用价值分析[J].中华疝和腹壁外科杂志(电子版),2018,12(3):226-228.
[3] Kulah B, Kulacoglu IH, Oruc MT, et al.Presentation and outcome of incarcerated external hernias in adults[J]. Am J Surg,2001,181(2):101-104.
[4] Kim JH, Ha HK, Kim JK, et al.Usefulness of known computed tomography and clinical criteria for diagnosing strangulation in small bowel obstruction: analysis of true and false interpretation groups in computed tomography[J]. World J Surg,2004,28(1):63-68.
[5] Clair DG, Beach JM.Mesenteric ischemia[J]. N Engl J Med,2016,374(10):959-968.
[6] Grootjans J, Lenaerts K, Buurman WA, et al.Life and death at the mucosalluminal interface: new perspectives on human intestinal ischemia-reperfusion[J]. World J Gastroenterol,2016,22(9):2760-2770.
[7] Koizumi M, Sata N, Kaneda Y, et al.Optimal timeline for emergency surgery in patients with strangulated groin hernias[J]. Hernia,2014,18(6):845-848.
[8] 唐健雄, 陈革. CT检查在疝外科急腹症诊断中的进展[J]. 国际外科学杂志,2016,43(10):658-660.
[9] Kocabas A, Kara K, Ozgur G, et al.Value of preoperative spirometry to predict postoperative pulmonary complications[J]. Respir Med,1996,90(1):25-33.
[10] 中华医学会外科学分会疝和腹壁外科学组, 中国医师协会外科医师分会疝和腹壁外科医师委员会. 成人腹股沟疝诊疗指南(2014年版)[J]. 中国实用外科杂志,2014,34(6):484-486.
