Banu P, Popa F, Constantin V D, Bălălău C, Nistor M
"Carol Davila" University of Medicine and Pharmacy, Bucharest; General Surgery Department, "Sf. Pantelimon" Emergency Hospital, Bucharest.
J Med Life. 2013 Sep 15;6(3):278-82. Epub 2013 Sep 25.
The surgical treatment of umbilical hernia in cirrhosis patients raises special management challenges. The attitude upon the repair of these hernias varies from expectancy or elective treatment in early stages of the disease to the surgical treatment only if complications occur.
We have assessed 22 consecutive cases of cirrhosis patients treated for complicated umbilical hernia in the Surgical Department of "Sf. Pantelimon" Emergency Hospital in Bucharest between January 2008 and December 2012. The patients' stratification was done in stages of liver disease based upon Child-Pugh classification. Complications that required emergency repair were the following: strangulation, incarceration and hernia rupture. The postoperative complications were ordered in five grades of severity based upon Clavien classification.
The severity of the complications was higher in advanced stages of liver cirrhosis, Child B and C. There were 5 deaths representing 22,7%, four of them in patients with Child C disease stage.
The incidence of morbidity and mortality after umbilical hernia repair in emergencies increases in advanced stages of liver cirrhosis. It is advisable to prevent complications occurrence and perform surgical repair of umbilical hernia in elective condition.
肝硬化患者脐疝的外科治疗带来了特殊的管理挑战。对于这些疝修补术的态度各不相同，从疾病早期的观察或择期治疗到仅在出现并发症时才进行手术治疗。
我们评估了2008年1月至2012年12月期间在布加勒斯特“圣潘泰利蒙”急诊医院外科治疗复杂脐疝的22例连续肝硬化患者病例。根据Child-Pugh分类法对患者的肝病阶段进行分层。需要急诊修补的并发症如下：绞窄、嵌顿和疝破裂。术后并发症根据Clavien分类法分为五个严重程度等级。
肝硬化晚期（Child B和C级）并发症的严重程度更高。有5例死亡，占22.7%，其中4例为Child C疾病阶段的患者。
肝硬化晚期急诊脐疝修补术后的发病率和死亡率增加。建议预防并发症的发生，并在择期情况下进行脐疝的手术修补。
