Malek S, Torella F, Edwards P R
Department of Surgery, Countess of Chester Hospital, Liverpool Road, Chester, UK.
Int J Clin Pract. 2004 Feb;58(2):207-9. doi: 10.1111/j.1368-5031.2004.0097.x.
Patients with groin herniae do not always seek medical advice and, when listed for surgery, often wait many months for elective repair. We audited our emergency admissions for complicated groin herniae to establish whether a change in policy for elective surgery could lower their incidence. We performed a retrospective review of all admissions for complicated groin herniae from 1 January 2000 to 31 December 2001. Besides outcome, we recorded patients' awareness of their diagnosis before admission and whether they had been listed for elective surgery. We identified 19 patients (16 men and three women) with an inguinal and 19 (four men and 15 women) with a femoral hernia. Sixteen (42%) knew of their hernia before admission (11 inguinal and five femoral), but only three had been awaiting surgical repair for 1, 7 and 26 weeks, respectively. The median (interquartile range) age was 70 (54-84) years in inguinal and 79 (64-88) years in femoral herniae. Surgery was performed in all but an 84-year-old man who died pre-operatively. Two patients with inguinal and 11 with femoral herniae required a laparotomy (p = 0.006). Bowel resection was necessary in one patient with an inguinal and 12 with femoral herniae (p = 0.001). Complications occurred in 12 cases (31%). Four patients, all with femoral herniae, died post-operatively, for an overall mortality of 13% (5/38). Morbidity and mortality for complicated groin hernia, particularly femoral, remain high. As most patients were elderly and unaware of their diagnosis, reducing waiting times for elective repair is unlikely to influence the incidence of complicated herniae.
腹股沟疝患者并不总是寻求医疗建议，而且在被列入手术名单后，往往要等待数月才能进行择期修补手术。我们对复杂腹股沟疝的急诊入院情况进行了审核，以确定择期手术政策的改变是否能够降低其发生率。我们对2000年1月1日至2001年12月31日期间所有复杂腹股沟疝入院病例进行了回顾性研究。除了治疗结果外，我们还记录了患者入院前对自身诊断的知晓情况以及他们是否已被列入择期手术名单。我们确定了19例腹股沟疝患者（16例男性和3例女性）以及19例股疝患者（4例男性和15例女性）。16例（42%）患者在入院前知晓自己患有疝气（11例腹股沟疝和5例股疝），但只有3例分别等待了1周、7周和26周进行手术修补。腹股沟疝患者的年龄中位数（四分位间距）为70（54 - 84）岁，股疝患者为79（64 - 88）岁。除了一名84岁术前死亡的男性患者外，所有患者均接受了手术。2例腹股沟疝患者和11例股疝患者需要进行剖腹手术（p = 0.006）。1例腹股沟疝患者和12例股疝患者需要进行肠切除（p = 0.001）。12例（31%）出现了并发症。4例患者均为股疝，术后死亡，总死亡率为13%（5/38）。复杂腹股沟疝，尤其是股疝的发病率和死亡率仍然很高。由于大多数患者年事已高且不知晓自己的诊断，缩短择期修补手术的等待时间不太可能影响复杂疝的发生率。
