Tang E S, Robertson D I, Whitehead M, Xu J, Hall S F
Department of Surgery, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada.
Institute for Clinical and Evaluative Sciences, Queen's Branch Abramsky Hall, 21 Arch St, Kingston, ON, K7L 3N6, Canada.
Hernia. 2018 Aug;22(4):603-609. doi: 10.1007/s10029-017-1704-x. Epub 2017 Nov 16.
Incisional hernias are a well described complication of abdominal surgery. Previous studies identified malignancy and diverticular disease as risk factors. We compared incisional hernia rates between colon resection for colorectal cancer (CRC) and diverticular disease (DD).
We performed a retrospective, population-based, matched cohort study. Provincial databases were linked through the Institute for Clinical Evaluative Sciences. These databases include all patients registered under the universal Ontario Health Insurance Plan. Patients aged 18-105 undergoing open colon resection, without ostomy formation between April 1, 2002 and March 31, 2009, were included. We excluded those with previous surgery, hernia, obstruction, and perforation. The primary outcomes were surgery for hernia repair, or diagnosis of hernia in clinic.
We identified 4660 cases of DD. These were matched 2:1 by age and gender to 8933 patients with CRC for a total of 13,593. At 5 years, incisional hernias occurred in 8.3% of patients in the CRC cohort, versus 13.1% of those undergoing surgery for DD. After adjusting for important confounders (comorbidity score, wound infection, age, diabetes, prednisone and chemotherapy), hernias were still more likely in patients with DD [HR 1.58, 95% Confidence Interval (CI) 1.43-1.76, P < 0.001]. The only significant covariate was wound infection (HR 1.63, 95% CI 1.43-1.87, P < 0.001).
Our study found that incisional hernias occur more commonly in patients with DD than CRC.
切口疝是腹部手术中一种已被充分描述的并发症。既往研究确定恶性肿瘤和憩室病为危险因素。我们比较了因结直肠癌（CRC）行结肠切除术和因憩室病（DD）行结肠切除术患者的切口疝发生率。
我们进行了一项基于人群的回顾性配对队列研究。省级数据库通过临床评估科学研究所进行链接。这些数据库包括安大略省医疗保险计划下登记的所有患者。纳入2002年4月1日至2009年3月31日期间接受开放性结肠切除术且未行造口术的18 - 105岁患者。我们排除了既往有手术史、疝、肠梗阻和穿孔的患者。主要结局为疝修补手术或临床诊断为疝。
我们确定了4660例憩室病患者。这些患者按年龄和性别以2:1的比例与8933例结直肠癌患者配对，共13593例。5年后，结直肠癌队列中8.3%的患者发生了切口疝，而行憩室病手术的患者中这一比例为13.1%。在调整了重要的混杂因素（合并症评分、伤口感染、年龄、糖尿病、泼尼松和化疗）后，憩室病患者发生疝的可能性仍然更高[风险比（HR）1.58，95%置信区间（CI）1.43 - 1.76，P < 0.001]。唯一显著的协变量是伤口感染（HR 1.63，95% CI 1.43 - 1.87，P < 0.001）。
我们的研究发现，憩室病患者比结直肠癌患者更易发生切口疝。
