McKay A, Dixon E, Bathe O, Sutherland F
Department of Surgery, Health Sciences Centre, University of Manitoba, GF-441, 820 Sherbrook St., Winnipeg, MB R3A 1R9, Canada.
Hernia. 2009 Oct;13(5):461-8. doi: 10.1007/s10029-009-0535-9. Epub 2009 Aug 4.
Umbilical hernias are common in cirrhotics, yet, their management poses several challenges. The objective of this paper was to evaluate the indications, selection criteria, and technical aspects of umbilical hernia repair in patients with cirrhosis and ascites.
An extensive review of the literature since 1980 was performed. A survey was also conducted to obtain expert consensus to supplement any available conclusions from the literature.
Nineteen surgeons (45%) responded to the survey. For asymptomatic hernias, all would consider hernia repair in Child's A cirrhosis, but not in more advanced disease, whereas the vast majority would consider the repair of complicated hernias. This seems to reflect the respondents' higher estimates of morbidity and mortality with more advanced liver disease. However, because the recent literature demonstrates much lower morbidity and mortality than in the past, many authors now advocate early elective repair. In addition, uncontrolled ascites appear to be strongly predictive of hernia recurrence (relative risk [RR] 8.5; 95% confidence interval [CI] 2.7-26.9).
While acknowledging the limitations of this study, it appears that the early repair of umbilical hernias in patients with cirrhosis and ascites is safer than it was in the past and can be considered for selected patients. This may avoid increased morbidity and mortality associated with urgent repair later on. The control of ascites is critical to a successful outcome. Urgent repair of umbilical hernia in cirrhotic patients is indicated when complications develop.
脐疝在肝硬化患者中很常见，但其治疗存在诸多挑战。本文的目的是评估肝硬化腹水患者脐疝修补术的适应证、选择标准和技术要点。
对1980年以来的文献进行了广泛回顾。还进行了一项调查以获得专家共识，以补充文献中任何可用的结论。
19名外科医生（45%）回复了调查。对于无症状疝，所有人都会考虑在Child A级肝硬化患者中进行疝修补术，但在病情更严重的患者中则不会，而绝大多数人会考虑修补复杂疝。这似乎反映了受访者对病情更严重的肝病患者发病率和死亡率的更高估计。然而，由于最近的文献显示发病率和死亡率比过去低得多，现在许多作者主张早期择期修补。此外，腹水未得到控制似乎强烈预示着疝复发（相对风险[RR]8.5；95%置信区间[CI]2.7 - 26.9）。
尽管认识到本研究的局限性，但肝硬化腹水患者脐疝的早期修补似乎比过去更安全，对于选定的患者可以考虑进行。这可能避免后期紧急修补带来的发病率和死亡率增加。腹水的控制对于成功的治疗结果至关重要。当出现并发症时，肝硬化患者脐疝的紧急修补是必要的。
