Sun Hui-Jun, Chen Yu-Zhuo, Sun Qiang, Liu Xiao-Jiang, Meng Xiang-Chao, Shi Jun-Zhong
Department of General Surgery, Third Central Hospital, Tianjin 300170, China.
Zhonghua Wai Ke Za Zhi. 2010 Aug 1;48(15):1130-2.
To review tension-free repairing for the patients with inguinal hernia complicated with cirrhosis and ascites.
Tension-free herniorrhaphy was performed in 16 cases with inguinal hernia complicated with cirrhosis and ascites from November 1999 to November 2003. The laboratory data before and after the operation were compared and analyzed in this group.
Of the patients, 13 cases were male and 3 were female, the mean age was (64 ± 12) years (range, 37 - 85 years). The liver function was classified as A degree in 4 case, B degree in 10 cases and C degree in 2 patients by using Child score. The operation was successfully carried out in all patients without complications and post-operative hepatoencephalopathy. There was no significant change in the plasma total protein, bilirubin, prothrombin activity and international normalized ratio (INR) after the operation. And the levels of albumin, globulin and white blood cell count changed remarkably after the operation (all P < 0.05). Plasma albumin level was obviously effected by the operation and treatment (P = 0.006). The mean follow-up time was 72.5 months (57 - 102 months). No recurrence occurred during the follow-up. There was no patient died in 30 days after the operation. Seven cases (43.8%) died in the later period of follow-up.
The tension-free repairing is feasible for the inguinal hernia complicated with cirrhosis and ascites. More attention should be paid to the level of plasma albumin and it should be corrected in time. The liver cirrhosis and its complications will progress after the operation with a poor prognosis.
探讨腹股沟疝合并肝硬化腹水患者的无张力修补术。
回顾性分析1999年11月至2003年11月期间16例腹股沟疝合并肝硬化腹水患者行无张力疝修补术的临床资料。比较并分析患者手术前后的实验室检查结果。
本组16例患者中,男13例,女3例;平均年龄(64±12)岁(37~85岁)。根据Child评分标准,肝功能A级4例,B级10例,C级2例。所有患者手术均顺利完成,无并发症及术后肝性脑病发生。术后血浆总蛋白、胆红素、凝血酶原活动度及国际标准化比值(INR)无明显变化;白蛋白、球蛋白及白细胞计数术后有明显改变(均P<0.05)。血浆白蛋白水平受手术及治疗影响明显(P=0.006)。平均随访时间72.5个月(57~102个月),随访期间无复发病例。术后30天内无死亡病例,随访后期死亡7例(43.8%)。
腹股沟疝合并肝硬化腹水患者行无张力修补术是可行的,应重视血浆白蛋白水平并及时纠正。术后肝硬化及其并发症仍会进展,预后较差。