引流液特征是否可作为切口疝修补术后血清肿形成的预测指标？
Do drainage liquid characteristics serve as predictors for seroma formation after incisional hernia repair?
机构信息
Department of Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany.
出版信息
Hernia. 2010 Apr;14(2):175-9. doi: 10.1007/s10029-009-0603-1. Epub 2009 Dec 10.
BACKGROUND
Though the occurrence of postoperative seroma after incisional hernia repair using mesh reinforcement is very common, little is known about the genesis of seroma formation. The aim of this study was to determine the characteristics of drainage liquid as a potential predictor for the development of seroma after incisional hernia mesh repair. Furthermore, the characteristics of drainage liquid were compared to the characteristics of seroma liquid.
METHODS
The incidence of postoperative seroma associated with pH value, concentration of lactate, total protein, albumin, propeptide-III-procollagen (P-III-P), hyaluronan, fibronectin and IL-1 receptor antagonist (IL-1-RA) in the drainage liquid were prospectively determined in 38 patients who underwent incisional hernia repair by lightweight polypropylene-polyglactin composite mesh (Vypro-II). The findings were compared to the seroma liquid characteristics of those patients who developed a seroma formation.
RESULTS
In 11 patients (29%), seroma formation was present after removal of the drainage. We observed significantly elevated mean drainage volume (148 +/- 64 ml vs. 93 +/- 71 ml; P = 0.014) and significantly reduced pH value (7.26 +/- 0.12 vs. 7.41 +/- 0.23; P = 0.016) and IL-1-RA (100 +/- 71 U/ml vs. 145 +/- 108 U/ml; P = 0.016) in the drainage liquid of patients with seroma formation in comparison to patients without seroma formation. In addition, we found significantly altered concentration of lactate (9.8 +/- 2.0 mmol/l vs. 5.5 +/- 1.4 mmol/l; P < 0.001), P-III-P (24 +/- 13 U/ml vs. 89 +/- 79 U/ml; P = 0.045) and fibronectin (0.10 +/- 0.03 g/l vs. 0.24 +/- 0.13 g/l; P = 0.005) in the drainage liquid in comparison to seroma liquid.
CONCLUSIONS
The pH value of wound solution proves to be a reliable predictor for the subsequent presence of seroma formation. Furthermore, our findings implicate that seroma formation cannot be seen as persistent drainage liquid.
背景
尽管使用网片加强修补切口疝术后发生血清肿非常常见，但对于血清肿形成的机制却知之甚少。本研究旨在确定引流液的特征是否可以作为预测切口疝网片修补术后血清肿发生的潜在指标。此外，还比较了引流液和血清肿液的特征。
方法
前瞻性研究了 38 例使用轻质聚丙烯-聚甘醇酸复合网片（Vypro-II）行切口疝修补术的患者，记录术后引流液的 pH 值、乳酸浓度、总蛋白、白蛋白、前 III 型胶原肽（P-III-P）、透明质酸、纤维连接蛋白和白细胞介素-1 受体拮抗剂（IL-1-RA）的浓度，并与发生血清肿的患者的血清肿液特征进行比较。
结果
11 例（29%）患者在拔除引流管后出现血清肿。与未发生血清肿的患者相比，发生血清肿的患者的引流液平均体积（148±64 ml 比 93±71 ml；P=0.014）明显增加，pH 值（7.26±0.12 比 7.41±0.23；P=0.016）和 IL-1-RA（100±71 U/ml 比 145±108 U/ml；P=0.016）明显降低。此外，我们还发现发生血清肿的患者的乳酸浓度（9.8±2.0 mmol/L 比 5.5±1.4 mmol/L；P<0.001）、P-III-P（24±13 U/ml 比 89±79 U/ml；P=0.045）和纤维连接蛋白（0.10±0.03 g/L 比 0.24±0.13 g/L；P=0.005）在引流液中明显低于血清肿液。
结论
伤口溶液的 pH 值是预测血清肿形成的可靠指标。此外，我们的研究结果表明，血清肿不能被视为持续的引流液。
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