Duan Sheng-Jun, Qiu Shao-Bo, Ding Nai-Yong, Liu Hua-Shui, Zhang Nai-Shun, Wei Ying-Tian
Am Surg. 2018 Feb 1;84(2):215-219.
The aim of this study was to determine the feasibility of prosthetic mesh repair according to the degree of bowel necrosis in the emergency management of acutely strangulated groin hernias. Emergency prosthetic mesh repair versus primary suture repair was randomly performed in 208 consecutive strangulated groin hernia patients with bowel necrosis between January 2005 and August 2016. The degree of bowel necrosis of each patient was determined according to a modified three-grade classification system. Patient characteristics sorted by repair method were analyzed by using Pearson's chi-squared tests. Correlations between mortality and wound-related morbidity with bowel necrosis grade and repair method were analyzed. There was no difference in gender, age, body mass index, comorbid diseases, hernia type (left or right, primary or recurrent), necrosis grade, and mortality between the mesh repair and suture repair groups (all P > 0.05). However, with regard to wound-related morbidity, there was significant difference between the two groups (P < 0.05). Mortality and wound-related morbidity showed significant relationship with necrosis grade, especially with regard to postoperative wound infection (P < 0.001). The wound infection rate with mesh repair was significantly higher than that with primary suture in Grade II and III necrosis patients (P < 0.05), but there was no difference in Grade I patients (P > 0.05). The use of prosthetic mesh in the emergency repair of acutely strangulated groin hernias seems to be as safe as suture-only repair in patients with noninfected strangulated bowel (Grade I necrosis). The use of prosthetic mesh repair is a rational choice made based on the degree of bowel necrosis in the emergency management of acutely strangulated hernias.
本研究的目的是确定在急性绞窄性腹股沟疝的急诊处理中，根据肠坏死程度进行人工补片修补的可行性。2005年1月至2016年8月期间，对208例连续性伴有肠坏死的绞窄性腹股沟疝患者随机进行急诊人工补片修补术与一期缝合修补术。根据改良的三级分类系统确定每位患者的肠坏死程度。采用Pearson卡方检验分析按修补方法分类的患者特征。分析死亡率和伤口相关并发症与肠坏死分级及修补方法之间的相关性。补片修补组与缝合修补组在性别、年龄、体重指数、合并疾病、疝类型（左侧或右侧、原发性或复发性）、坏死分级及死亡率方面均无差异（所有P>0.05）。然而，在伤口相关并发症方面，两组之间存在显著差异（P<0.05）。死亡率和伤口相关并发症与坏死分级显著相关，尤其是术后伤口感染（P<0.001）。在Ⅱ级和Ⅲ级坏死患者中，补片修补的伤口感染率显著高于一期缝合（P<0.05），但在Ⅰ级患者中无差异（P>0.05）。在急性绞窄性腹股沟疝的急诊修补中，对于未感染的绞窄肠管（Ⅰ级坏死）患者，使用人工补片似乎与单纯缝合修补一样安全。在急性绞窄性疝的急诊处理中，根据肠坏死程度选择人工补片修补是一种合理的选择。
