Cherla Deepa V, Viso Cristina P, Moses Maya L, Holihan Julie L, Ko Tien C, Kao Lillian S, Andrassy Richard J, Liang Mike K
Department of Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas; Center for Surgical Trials and Evidence-based Practice, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas.
Department of Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas.
J Surg Res. 2018 Jul;227:28-34. doi: 10.1016/j.jss.2017.11.014. Epub 2018 Mar 6.
Increasingly, abdominal wall hernias are being diagnosed incidentally through radiographic imaging. Such hernias are referred to as occult. However, the clinical significance of occult hernias is unknown. The objective of this study is to determine the prevalence of occult hernias and to assess the abdominal wall quality of life (AW-QOL) among patients with occult hernias.
A blinded, observational, cross-sectional study, October-December 2016, of patients presenting to single academic institution's general surgery clinics was performed. Inclusion criteria included all patients with a computed tomography scan of the abdomen or pelvis within the last year with no intervening abdominal or pelvic surgery. Patients were administered a validated AW-QOL survey and underwent a standardized clinical examination. Computed tomography scans were reviewed. Primary outcomes were prevalence and AW-QOL measured by the modified Activities Assessment Scale. AW-QOL of patients with no hernias was compared to that of those with occult hernias and clinically apparent hernias using Mann-Whitney U test.
A total of 250 patients were enrolled of whom 97 (38.8%) had a hernia noted on clinical examination and 132 (52.8%) had a hernia noted on radiographic imaging. The prevalence of occult hernias was 38 (15.2%). Patients with no hernia had a median (interquartile range) AW-QOL of 82.5 (55.0-95.3), patients with clinically apparent hernias had AW-QOL of 47.7 (31.2-81.6; P < 0.001), and patients with occult hernias had AW-QOL of 72.4 (38.5-97.2; P = 0.36).
Both clinically apparent and occult hernias are prevalent. However, only patients with clinically apparent hernias had differences in AW-QOL when compared to patients with no hernias. Prospective trials are needed to assess the outcomes of patients with occult hernias managed with and without surgical repair.
腹壁疝越来越多地通过影像学检查被偶然发现。这类疝被称为隐匿性疝。然而，隐匿性疝的临床意义尚不清楚。本研究的目的是确定隐匿性疝的患病率，并评估隐匿性疝患者的腹壁生活质量（AW-QOL）。
2016年10月至12月，对一家学术机构普通外科门诊的患者进行了一项双盲、观察性横断面研究。纳入标准包括去年内进行过腹部或盆腔计算机断层扫描且无中间腹部或盆腔手术的所有患者。患者接受了经过验证的AW-QOL调查，并接受了标准化临床检查。对计算机断层扫描进行了回顾。主要结局指标是患病率和采用改良活动评估量表测量的AW-QOL。使用曼-惠特尼U检验比较无疝患者与隐匿性疝患者及临床显性疝患者的AW-QOL。
共纳入250例患者，其中97例（38.8%）在临床检查中发现有疝，132例（52.8%）在影像学检查中发现有疝。隐匿性疝的患病率为38例（15.2%）。无疝患者的AW-QOL中位数（四分位间距）为82.5（55.0 - 95.3），临床显性疝患者的AW-QOL为47.7（31.2 - 81.6；P < 0.001），隐匿性疝患者的AW-QOL为72.4（38.5 - 97.2；P = 0.36）。
临床显性疝和隐匿性疝都很常见。然而，与无疝患者相比，只有临床显性疝患者的AW-QOL存在差异。需要进行前瞻性试验来评估接受或未接受手术修复的隐匿性疝患者的结局。
