CAJ | 학술논문

目的总结无张力疝修补手术治疗合并有肝硬化、腹水的腹股沟疝的经验.方法回顾性分析1999年11月至2003年11月采用无张力疝修补手术治疗的16例合并有肝硬化、腹水的腹股沟疝患者的资料.对手术前后的各临床、检查指标进行统计学对比分析.结果 16例患者中,男性13例,女性3例,平均年龄(64±12)岁(37～85岁).全部患者顺利治愈,无手术后并发症及肝昏迷发生.经手术前后对比,血浆总蛋白、血胆红素、凝血酶原活动度、凝血酶原国际标准化比值均无显著变化.清蛋白、球蛋白、白细胞计数三项指标手术前后对比差异有统计学意义(P均＜0.05).手术前后血浆清蛋白受手术和治疗影响较大(P=0.006).术后全组获得随访,平均随访72.5个月(57～102个月).随访期内无疝复发病例.无术后30 d内死亡病例.患者远期死亡7例,病死率为43.8%.结论对合并有肝硬化的腹股沟疝患者无张力修补手术是可行的.手术后应注意清蛋白的变化并及时补充.手术后肝硬化及相关并发症仍会继续进展,远期预后不良.
목적 총결무장력산수보수술치료합병유간경화、복수적복고구산적경험.방법 회고성분석1999년11월지2003년11월채용무장력산수보수술치료적16례합병유간경화、복수적복고구산환자적자료.대수술전후적각림상、검사지표진행통계학대비분석.결과 16례환자중,남성13례,녀성3례,평균년령(64±12)세(37～85세).전부환자순리치유,무수술후병발증급간혼미발생.경수술전후대비,혈장총단백、혈담홍소、응혈매원활동도、응혈매원국제표준화비치균무현저변화.청단백、구단백、백세포계수삼항지표수술전후대비차이유통계학의의(P균＜0.05).수술전후혈장청단백수수술화치료영향교대(P=0.006).술후전조획득수방,평균수방72.5개월(57～102개월).수방기내무산복발병례.무술후30 d내사망병례.환자원기사망7례,병사솔위43.8%.결론 대합병유간경화적복고구산환자무장력수보수술시가행적.수술후응주의청단백적변화병급시보충.수술후간경화급상관병발증잉회계속진전,원기예후불량.
Objective To review tension-free repairing for the patients with inguinal hernia complicated with cirrhosis and ascites. Methods Tension-free herniorrhaphy was performed in 16 cases with inguinal hernia complicated with cirrhosis and ascites from November 1999 to November 2003. The laboratory data before and after the operation were compared and analyzed in this group. Results Of the patients, 13 cases were male and 3 were female,the mean age was (64±12) years(range,37-85 years). The liver function was classified as A degree in 4 case, B degree in 10 cases and C degree in 2 patients by using Child score. The operation was successfully carried out in all patients without complications and post-operative hepatoencephalopathy. There was no significant change in the plasma total protein, bilirubin, prothrombin activity and international normalized ratio (INR) after the operation. And the levels of albumin, globulin and white blood cell count changed remarkably after the operation (all P <0. 05). Plasma albumin level was obviously effected by the operation and treatment (P = 0. 006). The mean follow-up time was 72. 5 months (57-102 months). No recurrence occurred during the follow-up. There was no patient died in 30 days after the operation. Seven cases (43. 8% ) died in the later period of follow-up. Conclusions The tension-free repairing is feasible for the inguinal hernia complicated with cirrhosis and ascites. More attention should be paid to the leve of plasma albumin and it should be corrected in time. The liver cirrhosis and its complications will progress after the operation with a poor prognosis.