剖腹术后切口疝发生率：对 15 年美国战争手术的调查。
Incisional hernia incidence following laparotomy for combat trauma: Investigating 15 years of US war surgery.
机构信息
From Walter Reed National Military Medical Center, Department of Surgery (V.M., C.D., J.S.), Bethesda, Maryland; Naval Health Research Center and Leidos (S.E., M.C.), San Diego, California; The George Washington School of Medicine (S.K.), Washington DC.
出版信息
J Trauma Acute Care Surg. 2020 Aug;89(2S Suppl 2):S200-S206. doi: 10.1097/TA.0000000000002769.
BACKGROUND
While the incidence of incisional hernia (IH) following elective laparotomy has been well described, incidence following emergent laparotomy for combat trauma has been much less studied. This retrospective cohort investigates the latter to better describe the burden IH represents for the injured warfighter.
METHODS
Data were obtained from the Expeditionary Medical Encounter Database for service members who survived a combat-related injury between January 2002 and December 2016 and underwent abdominal surgery in the first 30 days after injury. Incisional hernia diagnosis at least 30 days after injury was determined from inpatient and outpatient records in the Military Health System's Medical Data Repository.Means and SDs were reported for age and continuous Injury Severity Score, and frequency and percentages were reported for sex, branch of service, paygrade, mechanism of injury, Injury Severity Score, and maximum abdominal Abbreviated Injury Scale. Service members with and without a hernia diagnosis were compared using t test for continuous variables and χ or Fisher exact test (depending on cell size) for categorical variables.Multivariate logistic regression models were used to examine relationships between IH diagnosis and the covariates previously mentioned. Data analysis was completed using SAS software version 9.4 (SAS Institute Inc., Cary, NC).
RESULTS
Of the 570 laparotomy patients, 109 (19.1%) developed IH. Of these, 58 (53%) were diagnosed within the first year after injury. An additional 21 (19%) were diagnosed within the following year, and 30 (28%) were diagnosed more than 2 years after injury. Presence of gastrointestinal injury, Abbreviated Injury Scale score of 4 and 5, and 5-year increments of age were positively associated with hernia formation.
CONCLUSION
The incidence of postlaparotomy IH in combat trauma is 19.1%, a considerable source of disability for injured warfighters. Further investigation into hernia-preventive closure strategies is warranted.
LEVEL OF EVIDENCE
Therapeutic study, level IV.
背景
虽然择期剖腹手术后切口疝（IH）的发生率已有详细描述，但用于描述战斗创伤后紧急剖腹手术后 IH 发生率的研究则少得多。本回顾性队列研究旨在更好地描述 IH 给受伤作战人员带来的负担。
方法
从 2002 年 1 月至 2016 年 12 月期间，在因战斗受伤并于伤后 30 天内接受腹部手术的作战人员的远征医疗遭遇数据库中获取数据。从军事卫生系统医疗数据存储库的住院和门诊记录中确定伤后至少 30 天的 IH 诊断。报告年龄和连续损伤严重程度的平均值和标准差，报告性别、军种、薪级、损伤机制、损伤严重程度评分和最大腹部简明损伤评分的频率和百分比。使用 t 检验比较有和无疝诊断的服务成员的连续变量，使用 χ 或 Fisher 确切检验（取决于单元格大小）比较分类变量。使用多变量逻辑回归模型检查 IH 诊断与之前提到的协变量之间的关系。使用 SAS 软件版本 9.4（SAS Institute Inc.， Cary，NC）完成数据分析。
结果
在 570 例剖腹术患者中，109 例（19.1%）发生 IH。其中，58 例（53%）在受伤后 1 年内诊断，另有 21 例（19%）在随后 1 年内诊断，30 例（28%）在受伤后 2 年以上诊断。胃肠道损伤、简明损伤评分 4 分和 5 分以及年龄每增加 5 年与疝形成呈正相关。
结论
战斗创伤后剖腹手术后 IH 的发生率为 19.1%，这是受伤作战人员残疾的一个重要原因。需要进一步研究疝预防闭合策略。
证据等级
治疗研究，IV 级。
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