| 李江涛,胡凯峰,高 原,张 旭,张 力.腹股沟嵌顿疝患者行腹腔镜钩针法疝环闭合术效果及术后复发、引发慢性疼痛的危险因素分析[J].,2024,(15):2887-2891 |
| 腹股沟嵌顿疝患者行腹腔镜钩针法疝环闭合术效果及术后复发、引发慢性疼痛的危险因素分析 |
| Analysis of the Effect and Risk Factors for Postoperative Recurrence and Chronic Pain in Patients with Inguinal Incarcerated Hernia Undergoing Laparoscopic Crochet Hernia Ring Closure Surgery |
| 投稿时间：2024-02-03 修订日期：2024-02-27 |
| DOI：10.13241/j.cnki.pmb.2024.15.015 |
| 中文关键词: 腹股沟嵌顿疝 腹腔镜 钩针法疝环闭合术 术后复发 慢性疼痛 危险因素 |
| 英文关键词: Inguinal incarcerated hernia Laparoscopy Hook needle hernia ring closure surgery Postoperative recurrence Chronic pain Risk factors |
| 基金项目:陕西省自然科学基金项目（S2021 JCYB-18） |
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| 中文摘要: |
| 摘要 目的：探讨腹股沟嵌顿疝患者行腹腔镜钩针法疝环闭合术效果及术后复发、引发慢性疼痛的危险因素。方法：选取我院2018年1月到2021年12月收治的92例腹股沟嵌顿疝患者，均采取腹腔镜钩针法疝环闭合术治疗，分析所有患者的手术情况，并分别以术后复发、慢性疼痛作为因变量，采用logistics回归模型分析腹股沟嵌顿疝患者术后复发与发行疼痛的危险因素。结果：术后并发症发生率为7.61%（7/92），皮下血肿4例，切口感染1例，术后出血1例，迟发性肠穿孔1例。术后对所有患者进行2年随访，术后慢性疼痛发生率为16.30%（15/92），其中轻度疼痛5例，中度疼痛7例，重度疼痛3例。术后复发率为10.87%（10/92）；慢性疼痛组与非慢性疼痛组性别、年龄、合并基础疾病、疝解剖分类、病变位置、术后引流、补片类型、急诊手术情况对比无明显差异（P＞0.05），慢性疼痛组与非慢性疼痛组BMI、手术次数、术中神经保护、术前术区疼痛情况对比差异显著（P＜0.05）。复发组与非复发组年龄、合并冠心病、手术次数、术中神经保护、病变位置、术后引流、补片类型、术前术区疼痛情况对比无明显差异（P＞0.05），复发组与非复发组性别、BMI、合并糖尿病、高血压、疝解剖分类、急诊手术情况对比差异显著（P＜0.05）；BMI、并糖尿病、高血压、疝解剖分类为腹股沟嵌顿疝行腹股沟针法疝环闭合术术后复发的独立危险因素（P<0.05）；BMI、手术次数、术前术区疼痛为腹股沟嵌顿疝行腹股沟针法疝环闭合术术后慢性疼痛的独立危险因素，术中神经保护为保护因素（P<0.05）。结论：腹腔镜钩针法疝环闭合术治疗腹股沟嵌顿疝疗效显著，安全性较高，但术后依然有部分患者出现术后复发、慢性疼痛情况，其中BMI、并糖尿病、高血压、疝解剖分类为术后复发危险因素。BMI、手术次数、术前术区疼痛为术后慢性疼痛危险因素，术中神经保护为保护因素。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the effectiveness of laparoscopic hook needle hernia ring closure in patients with inguinal incarcerated hernia, as well as the risk factors for postoperative recurrence and chronic pain. Methods: A total of 92 patients with inguinal incarcerated hernia admitted to our hospital from January 2018 to December 2021 were selected, they underwent laparoscopic crochet hernia ring closure surgery. The surgical conditions of all patients were analyzed, and postoperative recurrence and chronic pain were used as variables. Logistic regression models were used to analyze the risk factors for postoperative recurrence and pain in inguinal incarcerated hernia patients. Results: The incidence of postoperative complications was 7.61% (7/92), with 4 cases of subcutaneous hematoma, 1 case of incision infection, 1 case of postoperative bleeding, and 1 case of delayed intestinal perforation. After 2 years of follow-up for all patients, the incidence of postoperative chronic pain was 16.30% (15/92), including 5 cases of mild pain, 7 cases of moderate pain, and 3 cases of severe pain. The postoperative recurrence rate was 10.87% (10/92); There was no difference in gender, age, comorbidities, hernia anatomical classification, lesion location, postoperative drainage, patch type, and emergency surgery between the chronic pain group and the non chronic pain group (P>0.05). However, there was a significant difference in BMI, number of surgeries, intraoperative neuroprotection, and preoperative pain in the operating area between the chronic pain group and the non chronic pain group (P<0.05). There was no difference between the recurrent group and the non recurrent group in terms of age, coronary heart disease, number of operations, intraoperative nerve protection, lesion location, postoperative drainage, patch type, preoperative pain in the operating area (P>0.05). There were significant differences between the recurrent group and the non recurrent group in terms of gender, BMI, diabetes, hypertension, hernia anatomy classification, and emergency surgery (P<0.05); BMI, diabetes, hypertension and hernia anatomy were classified as independent risk factors for recurrence after inguinal pin hernioplasty for incarcerated hernia (P<0.05); BMI, number of surgeries, and preoperative pain in the operating area are independent risk factors for postoperative chronic pain in inguinal incarcerated hernia treated with inguinal needle closure, while intraoperative neuroprotection is a protective factor (P<0.05). Conclusion: Laparoscopic hook needle herniorrhaphy for inguinal incarcerated hernia is effective and safe. However, some patients still have postoperative recurrence and chronic pain. BMI, diabetes, hypertension and hernia anatomy are risk factors for postoperative recurrence. BMI, number of surgeries, and preoperative pain in the surgical area are risk factors for postoperative chronic pain, while intraoperative neuroprotection is a protective factor. |
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