术前计算机断层扫描用于急性嵌顿性腹侧或腹股沟疝。
Preoperative computed tomography for acutely incarcerated ventral or inguinal hernia.
机构信息
University of Florida College of Medicine, Gainesville, FL.
Department of Surgery, University of Florida Health, Gainesville, FL.
出版信息
Surgery. 2022 Jul;172(1):193-197. doi: 10.1016/j.surg.2022.01.014. Epub 2022 Mar 15.
BACKGROUND
The utility of preoperative computed tomography for urgent abdominal wall hernia repair is unclear. This study tests the hypothesis that there is no difference in patient outcomes for acutely incarcerated ventral or inguinal hernias diagnosed by preoperative computed tomography versus clinical assessment alone.
METHODS
This retrospective cohort analysis included 270 adult patients undergoing urgent repair of ventral or inguinal hernia. Demographics, risk factors for complications, operative management strategies, and 1-year outcomes were compared between patients with (n = 179) versus without (n = 91) preoperative computed tomography.
RESULTS
Among 179 preoperative computed tomography scans, 15 (8.4%) were ordered by surgeons, and all others were ordered by referring providers. The computed tomography and no computed tomography groups had similar age (58 vs 58 years, P = .77), body mass index (30.7 vs 30.6 kg/m, P = .30), American Society of Anesthesiologists class (3.0 vs 3.0, P = .39), incidence of the systemic inflammatory response syndrome (19.0% vs 20.9%, P = .75), and incidence of recurrent hernia (16.8% vs 19.8%, P = .61). The interval between admission and incision was longer in the computed tomography group (11.2 hours vs 6.6 hours, P < .001). The computed tomography and no computed tomography groups had similar duration of surgery (125 minutes in both groups, P = .88), proportions of patients with biologic mesh (21.2% vs 17.6%, P = .52) and synthetic mesh (35.2% vs 46.2%, P = .09) placement, and 1-year outcomes including incidence of superficial (8.4% vs 6.6%, P = .81) and deep or organ/space surgical site infection (5.0% vs 6.6%, P = .59), mesh explant for infection (2.2% vs 3.3%, P = .69), reoperation for recurrent hernia (3.9% vs 1.1%, P = .27), and mortality (7.8% vs 4.4%, P = .44).
CONCLUSION
The performance of preoperative computed tomography was associated with a longer interval between admission and incision and no differences in mesh placement, mesh type, or 1-year patient outcomes. These results support the safety of performing urgent repair of acutely incarcerated ventral or inguinal hernias based on clinical assessment alone.
背景
术前计算机断层扫描在紧急腹壁疝修复中的作用尚不清楚。本研究检验了这样一个假设，即对于通过术前计算机断层扫描与单独临床评估诊断为急性嵌顿性腹疝或腹股沟疝的患者，其患者结局无差异。
方法
本回顾性队列分析纳入了 270 名接受紧急腹疝或腹股沟疝修复的成年患者。比较了术前计算机断层扫描组（n=179 例）和无术前计算机断层扫描组（n=91 例）的患者人口统计学资料、并发症危险因素、手术管理策略和 1 年结局。
结果
在 179 例术前计算机断层扫描中，有 15 例（8.4%）是由外科医生要求进行的，其余所有扫描都是由转诊医生要求进行的。计算机断层扫描组和无计算机断层扫描组的年龄（58 岁比 58 岁，P=0.77）、体重指数（30.7 千克/平方米比 30.6 千克/平方米，P=0.30）、美国麻醉医师协会分级（3.0 级比 3.0 级，P=0.39）、全身炎症反应综合征发生率（19.0%比 20.9%，P=0.75）和复发性疝发生率（16.8%比 19.8%，P=0.61）相似。计算机断层扫描组的入院至切口时间间隔较长（11.2 小时比 6.6 小时，P<0.001）。计算机断层扫描组和无计算机断层扫描组的手术持续时间相似（两组均为 125 分钟，P=0.88）、生物补片（21.2%比 17.6%，P=0.52）和合成补片（35.2%比 46.2%，P=0.09）的使用比例以及 1 年结局（包括浅表性（8.4%比 6.6%，P=0.81）和深部或器官/空间手术部位感染（5.0%比 6.6%，P=0.59）、感染性补片取出（2.2%比 3.3%，P=0.69）、复发性疝再次手术（3.9%比 1.1%，P=0.27）和死亡率（7.8%比 4.4%，P=0.44）无差异。
结论
术前计算机断层扫描的应用与入院至切口的时间间隔延长有关，但与补片放置、补片类型或 1 年患者结局无差异。这些结果支持仅基于临床评估即可安全进行急性嵌顿性腹疝或腹股沟疝的紧急修复。
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