Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA.
Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA.
J Am Coll Surg. 2014 May;218(5):920-8. doi: 10.1016/j.jamcollsurg.2014.01.050. Epub 2014 Feb 19.
We aimed to determine if an increased incidence of incisional hernias is present in patients undergoing sigmoidectomy for diverticulitis vs cancer. The pathophysiology of diverticulitis is poorly understood, but might involve a collagen vascular abnormality that can predispose to incisional hernia.
In this IRB-approved, retrospective study, patients who underwent sigmoid colectomies for diverticulitis or cancer between January 2003 and September 2012 were studied. Exclusion criteria included the development of surgical site infections and neoadjuvant chemoradiotherapy. A multivariate logistic regression was used with covariate adjustments for known risk factors for hernia development.
Four hundred forty-two patients (mean age 59.3 ± 13.9 years) with a median follow-up of 30 months were analyzed. The incidence of incisional hernia was 15.1% in diverticulitis patients vs 5.8% in the cancer cohort (41 of 271 vs 10 of 171; p = 0.003). Univariate analysis of risk factors associated with postoperative incisional hernia included steroid use (p = 0.007), wound packing (p = 0.001), higher American Society of Anesthesiologists classification (p = 0.001), absorbable suture closure (p = 0.02), blood transfusion (p = 0.04), stoma formation (p = 0.02), increased body mass index (p = 0.008), and history of incisional hernia (p = 0.00008). Multivariate logistic regression demonstrated a persistent association between diverticulitis and hernia development (p = 0.01). Odds of a hernia developing after sigmoidectomy for diverticulitis were 2.82 times greater than in the cancer cohort (95% CI, 1.3-6.6).
The incidence of an incisional hernia developing after a sigmoid colectomy is significantly higher when performed for diverticulitis as compared with cancer. This might be due to a connective tissue disorder, which predisposes to development of both diverticula and hernias.
我们旨在确定在因憩室炎和癌症而行乙状结肠切除术的患者中，切口疝的发生率是否增加。憩室炎的病理生理学尚未完全了解，但可能涉及胶原血管异常，从而易患切口疝。
在这项经机构审查委员会批准的回顾性研究中，研究了 2003 年 1 月至 2012 年 9 月期间因憩室炎或癌症而行乙状结肠切除术的患者。排除标准包括手术部位感染和新辅助放化疗的发展。使用多变量逻辑回归，并对已知的疝发展风险因素进行协变量调整。
共分析了 442 例（平均年龄 59.3 ± 13.9 岁）患者，中位随访时间为 30 个月。憩室炎患者切口疝的发生率为 15.1%，而癌症组为 5.8%（271 例中有 41 例，171 例中有 10 例；p = 0.003）。与术后切口疝相关的单因素分析风险因素包括使用类固醇（p = 0.007）、伤口填塞（p = 0.001）、较高的美国麻醉师协会分级（p = 0.001）、可吸收缝线缝合（p = 0.02）、输血（p = 0.04）、造口形成（p = 0.02）、体重指数增加（p = 0.008）和切口疝史（p = 0.00008）。多变量逻辑回归显示憩室炎与疝发展之间存在持续关联（p = 0.01）。与癌症组相比，憩室炎患者行乙状结肠切除术后发生疝的几率增加了 2.82 倍（95%CI，1.3-6.6）。
与癌症相比，因憩室炎而行乙状结肠切除术的患者发生切口疝的发生率明显更高。这可能是由于结缔组织疾病，导致憩室和疝的同时发生。
