摘要
目的分析老年腹腔镜下腹股沟疝修补手术(IHR)术后并发症的发生情况及其影响因素,并制定防范措施。方法选取2018年1月至2021年12月秦皇岛市第一医院收治的567例IHR术后老年患者作为研究对象,根据术后有无并发症发生将其分为并发症组(n=38)和无并发症组(n=529),分析所选患者的临床资料,采用单因素和Logistic回归分析筛选老年腹腔镜下IHR术后并发症的影响因素。结果本研究共纳入567例IHR术后老年患者,其中术后发生并发症者38例,发生率为6.70%。其中血清肿占比最高,为31.58%,其次为慢性疼痛占21.05%,第三为手术部位感染占15.79%。2组患者临床资料对比显示体重指数(BMI)、慢性阻塞性肺疾病(COPD)、嵌顿疝、疝囊直径、手术时间、术中出血量、术后镇痛药物类型以及术后首次排尿时间等资料间差异有统计学意义(P<0.05)。Logistic回归分析结果表明,BMI>24 kg/m^(2)(OR=3.031,95%CI 1.421~6.466,P=0.004)、COPD(OR=3.315,95%CI 1.539~7.141,P=0.002)、嵌顿疝(OR=3.070,95%CI 1.446~6.517,P=0.003)、疝囊直径>5 cm(OR=3.416,95%CI 1.577~7.401,P=0.002)、手术时间>100 min(OR=3.423,95%CI 1.561~7.506,P=0.002)、术中出血量>10 ml(OR=2.626,95%CI 1.233~5.591,P=0.012)、术后镇痛药物应用麻醉类(OR=3.509,95%CI 1.641~7.503,P=0.001)是影响IHR术后发生并发症的危险因素。结论BMI>24 kg/m^(2)、COPD、嵌顿疝、疝囊直径>5 cm、手术时间>100 min、术中出血量>10 ml、术后镇痛药物应用麻醉类是影响IHR术后发生并发症的危险因素,医务人员可通过危险因素识别高风险患者,同时加以一定的干预措施,预防IHR术后并发症的发生。
Objective To analyze the incidence and influencing factors of postoperative complications of laparoscopic inguinal hernia repair(IHR)in the elderly,and to formulate preventive measures.Methods A total of 567 elderly patients admitted to Qinhuangdao First Hospital from January 2018 to December 2021 after IHR surgery were selected as the research objects.According to the occurrence of postoperative complications,they were divided into the occurrence group(n=38)and the non-occurrence group(n=529),and the clinical data of the selected patients were analyzed.Univariate and logistic regression analyses were used to screen the influencing factors of postoperative complications of laparoscopic IHR in the elderly.Results A total of 567 elderly patients after IHR surgery were included in this study,among whom postoperative complications occurred in 38 cases(6.70%),among which seroma was the highest(31.58%),chronic pain was the second(21.05%)and surgical site infection was the third(15.79%).Comparison of clinical data between the two groups showed differences in BMI,COPD,incarcerated hernia,hernia sac diameter,operation time,intraoperative blood loss,postoperative analgesic drug type and postoperative first urination time(P<0.05).Logistic regression analysis showed that BMI>24 kg/m^(2)(OR=3.031,95%CI 1.421~6.466,P=0.004),COPD(OR=3.315,95%CI 1.539~7.141,P=0.002),incarcerated hernia(OR=3.070,95%CI 1.446~6.517,P=0.003),hernia sac diameter>5 cm(OR=3.416,95%CI 1.577~7.401,P=0.002),Operative time>100 min(OR=3.423,95%CI 1.561~7.506,P=0.002),intraoperative blood loss>10 ml(OR=2.626,95%CI 1.233~5.591,P=0.012)and anesthesia used for postoperative analgesia(OR=3.509,95%CI 1.641~7.503,P=0.001)were the risk factors affecting postoperative complications of IHR.Conclusion BMI>24 kg/m^(2),COPD,trapped hernia,hernia sac diameter>5 cm,operation time>100 min,intraoperative blood loss>10 ml,postoperative analgesic drugs and anesthesia are the risk factors affecting postoperative complications of IHR.Medical staff can identify high-risk patients base on risk factors and take certain intervention measures to prevent postoperative complications of IHR.
作者
于铭
吴曦
吴运舸
马广恩
郭运生
Yu Ming;Wu Xi;Wu Yunge;Ma Guangen;Guo Yunsheng(General Surgery Department of Qinhuangdao First Hospital,Hebei Province,Qinhuangdao 066001,China;The Second Department of General Surgery,Qinhuangdao First Hospital,Hebei Province,Qinhuangdao 066001,China)
出处
《中华疝和腹壁外科杂志（电子版）》
2023年第3期285-290,共6页
Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)
基金
2017年秦皇岛市市级重点研发计划(第三批)(201703A188)
