Yang L, Wang H, Liang X, Chen T, Chen W, Song Y, Wang J
Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 S. Dongfang Road, Shanghai, 200127, China.
Hernia. 2015 Apr;19(2):279-83. doi: 10.1007/s10029-014-1275-z. Epub 2014 Jun 13.
Although some recent reports have proven that incarcerated and/or strangulated hernia is not contraindication to mesh repair, there is still a common concern owing to increased rate of postoperative surgical site infection (SSI). The aim of this clinical study was to evaluate factors that increase the risk of SSI after incarcerated hernia repair, and to identify the pathogens related to SSI.
A retrospective analysis was performed on data collected prospectively over a 4-year interval from January 2007 to December 2011. A total of 121 patients who underwent emergency surgery for incarcerated hernias were analyzed.
107 hernias were repaired using mesh versus 14 primary suture repairs. SSIs were observed in 9 of the 121 patients. Of 15 preoperative and intraoperative variables studied, duration of symptoms, diabetes mellitus, present of ileus, bowel resection or mesh repair performed, bacteria present in hernia sac and cloudy fluid in hernia sac were found to be significant factors predicting SSI. On multivariate analysis only bowel resection, duration of symptoms and bacteria present in hernia sac were independent variables. The most common pathogen found in hernia sac and cultured from wound drainage or swab was Escherichia coli. The strains of bacteria cultured from wound drainage or swab were same as those cultured from fluid in hernia sac in six of nine patients.
Gut-sourced E. coli is an important common organisms associated with SSI after incarcerated hernia repair. Prosthetic mesh could be used when no bowel resection is performed, duration of symptoms less than 24 h and fluid hernia sac is clear.
尽管近期一些报告已证实嵌顿性和/或绞窄性疝并非网状修补术的禁忌证，但由于术后手术部位感染（SSI）发生率增加，人们仍普遍担忧。本临床研究的目的是评估嵌顿疝修补术后增加SSI风险的因素，并确定与SSI相关的病原体。
对2007年1月至2011年12月4年间前瞻性收集的数据进行回顾性分析。共分析了121例行嵌顿疝急诊手术的患者。
107例疝采用网状修补，14例采用一期缝合修补。121例患者中有9例发生SSI。在研究的15个术前和术中变量中，症状持续时间、糖尿病、肠梗阻、行肠切除或网状修补、疝囊内存在细菌以及疝囊内有混浊液体被发现是预测SSI的重要因素。多因素分析显示，只有肠切除、症状持续时间和疝囊内存在细菌是独立变量。在疝囊内发现并从伤口引流液或拭子培养出的最常见病原体是大肠杆菌。9例患者中有6例从伤口引流液或拭子培养出的细菌菌株与从疝囊内液体培养出的相同。
肠道来源的大肠杆菌是嵌顿疝修补术后与SSI相关的重要常见病原体。在未行肠切除、症状持续时间小于24小时且疝囊液清澈时可使用人工补片。
