腹股沟疝修补术血管并发症的预防与治疗

Prevention and treatment of vascular complications of inguinal hernia repair

  • 摘要: 目的:探讨腹股沟疝修补术相关血管损伤并发症的预防与治疗方法。
    方法:采用回顾性横断面描述性研究方法。收集2005年6月至2016年3月重庆医科大学附属第一医院收治的22例腹股沟疝修补术后出现血管并发症患者的临床资料。观察指标:(1)腹股沟疝修补术后血管并发症情况:血管损伤、腹膜前间隙出血或血肿形成、血栓形成或血管栓塞。(2)治疗情况。(3)随访情况。出院后15 d,采用电话方式进行随访,了解患者一般状况、症状的转归及药物后续治疗状况。随访时间截至2016年4月。
    结果: (1)腹股沟疝修补术后血管并发症情况:22例患者中,腹膜前间隙出血及血肿形成8例(死亡冠血管损伤 2例、腹壁下动脉损伤3例、其他原因不明的腹膜前出血3例),股静脉损伤3例,股动脉损伤1例,下肢深静脉血栓形成8例(其中2例出现肺栓塞),股动脉及腘动脉栓塞2例。(2)治疗情况:22例患者中,20例患者均取得良好治疗效果,其中1例动脉栓塞患者因处理及时避免肢体坏死,1例因缺血时间较长,发生部分足趾缺血坏死,其余患者经修补或重建血管获得良好疗效; 1例腹壁下动脉损伤和1例股静脉损伤患者因失血性休克死亡。(3)随访情况:22例患者中,20例获得随访。患者随访2周一般状况良好,出血患者未再发生明显失血症状;深静脉血栓患者无明显肢体肿胀加重情况,下肢动脉栓塞患者肢体缺血无明显加重;均按照出院医嘱进行服药。
    结论:针对腹股沟疝修补术后血管并发症发生特点,采取不同处理措施可取得较好疗效。

     

    Abstract: Objective:To explore the prevention and treatment of complications of vascular injury after inguinal hernia repair.
    Methods:The retrospective crosssectional and descriptive study was adopted. The clinical data of 22 patients with vascular injury after inguinal hernia repair who were admitted to the First Affiliated Hospital of Chongqing Medical University between June 2005 and March 2016 were collected. Observation indicators included: (1) the vascular complications after inguinal hernia repair: vascular injury, peritoneal interstitial hemorrhage or hematoma formation, thrombosis and vascular embolization, (2) treatment, (3) followup. Patients were followed up by telephone interview at 15 days after discharge up to April 2016, and conditions of patients, recovery of symptoms and subsequent pharmacotherapy were detected.
    Results:(1) The vascular complications after inguinal hernia repair: of 22 patients, peritoneal interstitial hemorrhage or hematoma formation was detected in 8 patients (vascular injury of corona mortis in 2 patients, inferior epigastric artery injury in 3 patients and unexplained peritoneal interstitial hemorrhage in 3 patients), femoral vein injury in 3 patients, femoral artery injury in 1 patient, deep vein thrombosis of the double lower limbs in 8 patients (including 2 with pulmonary embolism) and femoral and popliteal artery embolism in 2 patients. (2) Treatments: 20 of 22 patients had good therapeutic effect, 1 patient with arterial embolism received timely treatment avoiding the necrosis of limbs, 1 ischemic necrosis of partial toes and the other patients had good effect through vascular repair or construction. One patient with inferior epigastric artery injury and 1 with femoral vein injury died of hemorrhagic shock. (3) Followup: 20 of 22 patients were followed up for 2 weeks, with good conditions. Patients′ hemorrhage had been improved. The symptoms of patients with deep vein thrombosis and arterial embolism of lower limbs didn′t become obviously aggravated, and they took the medicine as medical advice.
    Conclusion:The different treatments are conducted according to the occuring characteristics of vascular complications, with better outcomes.

     

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