Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Number 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China.
Department of Hernia and Abdominal Wall Surgery, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.
Hernia. 2024 Aug;28(4):1373-1379. doi: 10.1007/s10029-024-03056-2. Epub 2024 Apr 30.
Incarcerated femoral hernia patients had high risk of hernia contents necrosis. We provide our experience of management ischemia and necrosis of hernia contents in emergency incarcerated femoral hernia patients, and to investigate its risk factors.
This is a case-control study. Eighty-nine incarcerated femoral patients who underwent emergency surgery from January 2015 to December 2021 were included, and divided into normal group (60 cases) and ischemia/necrosis group (29 cases) according to the intraoperative condition of hernia contents. The surgical methods, intraoperative and postoperative conditions were compared between the two groups. Multivariate logistic regression was used to analyze the risk factors of ischemia and necrosis of hernia contents.
Open preperitoneal tension-free repair was the most commonly used surgical methods (68.5%) for incarcerated femoral patients. The utilization rate of laparoscopic repair in the ischemia/necrosis group was lower than that in the normal group (13.8% vs. 20.0%, P = 0.475). The proportion of mesh placement in the normal group was significantly higher than that in the ischemia/necrosis group (98.3% vs 65.5%, P < 0.001). The hernia contents resection rate (55.2% vs 1.7%), operation time (90 vs 40 min), intraoperative bleeding (5 vs 2 ml), ICU admission rate (31.0% vs 1.7%), and hospital stay (7 vs 4 d) were significantly higher in the ischemia/necrosis group than those in normal group. Results of multivariate logistic regression showed that incarceration time more than 9 h (aOR = 19.3, 95%CI: 1.9-192.9) was an independent risk factor for ischemia and necrosis of hernia contents in emergency incarcerated femoral hernia patients.
Open tension-free repair was the most commonly used surgical methods for emergency incarcerated femoral hernia patients. Ischemia and necrosis of hernia contents will increase bowel resection rate and prolong operation and hospital stay. Long incarceration time is an independent risk factor for ischemia and necrosis of hernia contents.
嵌顿性股疝患者疝内容物易发生坏死。我们提供了我们在紧急嵌顿性股疝患者中处理疝内容物缺血和坏死的经验，并探讨了其危险因素。
这是一项病例对照研究。纳入 2015 年 1 月至 2021 年 12 月期间行紧急手术的 89 例嵌顿性股疝患者，根据疝内容物的术中情况分为正常组（60 例）和缺血/坏死组（29 例）。比较两组患者的手术方法、术中及术后情况。采用多变量 logistic 回归分析疝内容物缺血坏死的危险因素。
开放式腹膜前无张力修补术是最常用于嵌顿性股疝患者的手术方法（68.5%）。缺血/坏死组腹腔镜修补的使用率低于正常组（13.8%比 20.0%，P=0.475）。正常组网片放置比例明显高于缺血/坏死组（98.3%比 65.5%，P<0.001）。缺血/坏死组疝内容物切除率（55.2%比 1.7%）、手术时间（90 分钟比 40 分钟）、术中出血量（5 毫升比 2 毫升）、ICU 入住率（31.0%比 1.7%）和住院时间（7 天比 4 天）明显高于正常组。多变量 logistic 回归分析结果显示，嵌顿时间超过 9 小时（aOR=19.3，95%CI：1.9-192.9）是紧急嵌顿性股疝患者疝内容物缺血坏死的独立危险因素。
开放式无张力修补术是紧急嵌顿性股疝患者最常用的手术方法。疝内容物缺血坏死会增加肠切除率，延长手术和住院时间。嵌顿时间长是疝内容物缺血坏死的独立危险因素。
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