Alvarez-Pérez José Antonio, Baldonedo-Cernuda Ricardo Francisco, García-Bear Isabel, Suárez-Solís José Armando, Alvarez-Martínez Paloma, Jorge-Barreiro José Ignacio
Servicio de Cirugía General, Hospital San Agustín, Avilés, Asturias, Spain.
Cir Esp. 2005 Jan;77(1):40-5. doi: 10.1016/s0009-739x(05)70802-2.
The aim of this study was to determine the clinical presentation and outcome of incarcerated external hernias in adults, as well as to identify the factors that might have some influence on outcome.
A retrospective study of 230 adult patients who underwent emergency surgical repair of incarcerated external hernias from 1992 to 2001 was performed. The characteristics of clinical presentation, type of anesthesia, surgical procedures, complications and mortality were studied. To determine clinical factors that might have some influence on outcome, an univariate analysis was also performed.
There were 77 femoral hernias, 70 inguinal, 43 umbilical and 40 incisional hernias. Seventy-four patients (32.2%) presented after 48 h of symptom onset. Significant associated diseases were found in 135 patients (58.7%). General anesthesia was used in 140 patients (60.9%), spinal anesthesia in 86 patients and local anesthesia in four patients. The most commonly used procedures were anatomic repair and tension-free hernioplasty. Bowel resection was required in 31 patients (13.5%). Overall and major morbidity and mortality were 37.8%, 10% and 3.9%, respectively. Factors that were significantly associated with unfavorable outcome were longer duration of symptoms, late hospitalization, concomitant diseases, and a high ASA class.
External hernias produce elevated morbidity and mortality if treatment is undertaken as an emergency. Thus, early diagnosis and elective repair of uncomplicated hernias should be performed in adults.
本研究旨在确定成人嵌顿性外疝的临床表现及预后，并找出可能对预后有影响的因素。
对1992年至2001年间接受嵌顿性外疝急诊手术修补的230例成年患者进行回顾性研究。研究临床表现特征、麻醉类型、手术方式、并发症及死亡率。为确定可能对预后有影响的临床因素，还进行了单因素分析。
有77例股疝、70例腹股沟疝、43例脐疝和40例切口疝。74例患者（32.2%）在症状出现48小时后就诊。135例患者（58.7%）发现有显著相关疾病。140例患者（60.9%）采用全身麻醉，86例采用脊髓麻醉，4例采用局部麻醉。最常用的手术方式是解剖修复和无张力疝修补术。31例患者（13.5%）需要行肠切除术。总体发病率、主要发病率和死亡率分别为37.8%、10%和3.9%。与不良预后显著相关的因素是症状持续时间长、住院晚、合并疾病以及美国麻醉医师协会（ASA）分级高。
如果作为急诊进行治疗，外疝会导致发病率和死亡率升高。因此，成人应尽早诊断并择期修补无并发症的疝。
