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腹股沟疝和股疝修补术的并发症概述

Author
David C Brooks, MD
Section Editor
Richard Turnage, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS
Translators
李俊生, 主任医师，副教授

引言

腹股沟疝或股疝修补术后的并发症相对常见。急诊疝修补术和复发疝修补术后的并发症发病率较择期修补术高。随着修补技术逐渐转型为无张力修补术，疝复发已经比较少见，而疝修补术后神经痛等其他并发症则变得更为突出。

可在围手术期发生的并发症包括：伤口血清肿/血肿、尿潴留、膀胱损伤和浅表伤口感染；而在疝修补术后较后期发生的并发症则包括：持续性腹股沟区疼痛和疝修补术后神经痛、睾丸并发症、深部伤口/补片感染、疝复发，以及补片移位和侵蚀。

本文将总结腹股沟疝和股疝修补术的相关并发症。腹股沟疝和股疝修补术的手术技术，包括预防修补术相关并发症的方法见其他专题。 (参见“成人腹股沟疝和股疝的开放修补术”和“成人腹腔镜腹股沟疝和股疝修补”)

发病率

腹股沟疝或股疝修补术后的并发症相对常见，并发症发病率取决于进行疝修补术的临床情况，以及疝的部位和种类[1]。

限期手术和急诊手术比择期手术的并发症发病率高[2,3]。在一项对1034例腹股沟区域疝修补术患者的回顾性研究中，急诊疝修补术的总体并发症发病率为27%，择期修补术为15.1%[3]。复发疝修补术与原发疝修补术相比，并发症发病率也更高。比较开放式疝修补术与腹腔镜疝修补术的研究显示，两者的总体并发症发病率相近；然而，并发症的性质有所差异。具体可识别的差异将在下文讨论。 (参见“成人腹股沟疝和股疝的治疗概述”)

            

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Literature review current through: 2017-06 . | This topic last updated: 2017-04-19.
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References
Top
  1. Matthews RD, Anthony T, Kim LT, et al. Factors associated with postoperative complications and hernia recurrence for patients undergoing inguinal hernia repair: a report from the VA Cooperative Hernia Study Group. Am J Surg 2007; 194:611.
  2. Koch A, Edwards A, Haapaniemi S, et al. Prospective evaluation of 6895 groin hernia repairs in women. Br J Surg 2005; 92:1553.
  3. Abi-Haidar Y, Sanchez V, Itani KM. Risk factors and outcomes of acute versus elective groin hernia surgery. J Am Coll Surg 2011; 213:363.
  4. Fitzgibbons RJ Jr, Giobbie-Hurder A, Gibbs JO, et al. Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. JAMA 2006; 295:285.
  5. Hawn MT, Itani KM, Giobbie-Hurder A, et al. Patient-reported outcomes after inguinal herniorrhaphy. Surgery 2006; 140:198.
  6. Falagas ME, Kasiakou SK. Mesh-related infections after hernia repair surgery. Clin Microbiol Infect 2005; 11:3.
  7. Kocot A, Gerharz EW, Riedmiller H. Urological complications of laparoscopic inguinal hernia repair: a case series. Hernia 2011; 15:583.
  8. Gulino G, Antonucci M, Palermo G, et al. Urological complications following inguinal hernioplasty. Arch Ital Urol Androl 2012; 84:105.
  9. Köckerling F, Jacob DA, Bittner R, et al. Risk of postoperative urinary retention after laparoscopic (TAPP) or endoscopic (TEP) inguinal hernia repair. Surg Endosc 2013; 27:1049.
  10. Bittner R, Schmedt CG, Schwarz J, et al. Laparoscopic transperitoneal procedure for routine repair of groin hernia. Br J Surg 2002; 89:1062.
  11. Winslow ER, Quasebarth M, Brunt LM. Perioperative outcomes and complications of open vs laparoscopic extraperitoneal inguinal hernia repair in a mature surgical practice. Surg Endosc 2004; 18:221.
  12. Inaba T, Okinaga K, Fukushima R, et al. Chronic pain and discomfort after inguinal hernia repair. Surg Today 2012; 42:825.
  13. Schmedt CG, Sauerland S, Bittner R. Comparison of endoscopic procedures vs Lichtenstein and other open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Surg Endosc 2005; 19:188.
  14. Schwab JR et al. After 10 years and 1.903 inguinal hernias, what is the outcome for the laparoscopic repair? Surgical Endoscopy. 2002;16:1201.
  15. Matthews R, Anthony T, Kim LT, Wang J, Fitzgibbon R, Giobbie-Hurder A, Reda D, Itani K, Neumayer L. Factors associated with postoperative complications and hernia recurrence for patients undergoing inguinal hernia repair. The American Journal of Surgery. 2007;194:611.
  16. Berney CR. Risk of postoperative urinary retention after laparoscopic (TAPP) or endoscopic (TEP) inguinal hernia repair. Surg Endosc 2013; 27:694.
  17. Kaul A, Hutfless S, Le H, et al. Staple versus fibrin glue fixation in laparoscopic total extraperitoneal repair of inguinal hernia: a systematic review and meta-analysis. Surg Endosc 2012; 26:1269.
  18. Tam KW, Liang HH, Chai CY. Outcomes of staple fixation of mesh versus nonfixation in laparoscopic total extraperitoneal inguinal repair: a meta-analysis of randomized controlled trials. World J Surg 2010; 34:3065.
  19. Garg P, Rajagopal M, Varghese V, Ismail M. Laparoscopic total extraperitoneal inguinal hernia repair with nonfixation of the mesh for 1,692 hernias. Surg Endosc 2009; 23:1241.
  20. Garg P, Nair S, Shereef M, et al. Mesh fixation compared to nonfixation in total extraperitoneal inguinal hernia repair: a randomized controlled trial in a rural center in India. Surg Endosc 2011; 25:3300.
  21. Bittner R, Arregui ME, Bisgaard T, et al. Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS)]. Surg Endosc 2011; 25:2773.
  22. Doehn C, Fornara P, Miglietti G, Jocham D. Uraemia after laparoscopic bilateral hernia repair. Nephrol Dial Transplant 1998; 13:1265.
  23. Schwab JR, Beaird DA, Ramshaw BJ, et al. After 10 years and 1903 inguinal hernias, what is the outcome for the laparoscopic repair? Surg Endosc 2002; 16:1201.
  24. Sanchez-Manuel FJ, Seco-Gil JL. Antibiotic prophylaxis for hernia repair. Cochrane Database Syst Rev 2003; :CD003769.
  25. Sanabria A, Domínguez LC, Valdivieso E, Gómez G. Prophylactic antibiotics for mesh inguinal hernioplasty: a meta-analysis. Ann Surg 2007; 245:392.
  26. Gilbert AI, Felton LL. Infection in inguinal hernia repair considering biomaterials and antibiotics. Surg Gynecol Obstet 1993; 177:126.
  27. Alfieri S, Amid PK, Campanelli G, et al. International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Hernia 2011; 15:239.
  28. Eklund A, Rudberg C, Smedberg S, et al. Short-term results of a randomized clinical trial comparing Lichtenstein open repair with totally extraperitoneal laparoscopic inguinal hernia repair. Br J Surg 2006; 93:1060.
  29. Grant AM, Scott NW, O'Dwyer PJ, MRC Laparoscopic Groin Hernia Trial Group. Five-year follow-up of a randomized trial to assess pain and numbness after laparoscopic or open repair of groin hernia. Br J Surg 2004; 91:1570.
  30. Shin D, Lipshultz LI, Goldstein M, et al. Herniorrhaphy with polypropylene mesh causing inguinal vasal obstruction: a preventable cause of obstructive azoospermia. Ann Surg 2005; 241:553.
  31. Delikoukos S, Tzovaras G, Liakou P, et al. Late-onset deep mesh infection after inguinal hernia repair. Hernia 2007; 11:15.
  32. Moon V, Chaudry GA, Choy C, Ferzli GS. Mesh infection in the era of laparoscopy. J Laparoendosc Adv Surg Tech A 2004; 14:349.
  33. Neumayer L, Giobbie-Hurder A, Jonasson O, et al. Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 2004; 350:1819.
  34. Costerton JW, Stewart PS, Greenberg EP. Bacterial biofilms: a common cause of persistent infections. Science 1999; 284:1318.
  35. Donlan RM. Biofilm formation: a clinically relevant microbiological process. Clin Infect Dis 2001; 33:1387.
  36. Vuong C, Gerke C, Somerville GA, et al. Quorum-sensing control of biofilm factors in Staphylococcus epidermidis. J Infect Dis 2003; 188:706.
  37. Taylor SG, O'Dwyer PJ. Chronic groin sepsis following tension-free inguinal hernioplasty. Br J Surg 1999; 86:562.
  38. Nolla-Salas J, Torres-Rodríguez JM, Grau S, et al. Successful treatment with liposomal amphotericin B of an intraabdomianl abscess due to Candida norvegensis associated with a Gore-Tex mesh infection. Scand J Infect Dis 2000; 32:560.
  39. Matthews MR, Caruso DM, Tsujimura RB, et al. Ventral hernia synthetic mesh repair infected by Mycobacterium fortuitum. Am Surg 1999; 65:1035.
  40. Deysine M. Pathophysiology, prevention, and management of prosthetic infections in hernia surgery. Surg Clin North Am 1998; 78:1105.
  41. Kuo YC, Mondschein JI, Soulen MC, et al. Drainage of collections associated with hernia mesh: is it worthwhile? J Vasc Interv Radiol 2010; 21:362.
  42. Cingi A, Manukyan MN, Güllüoğlu BM, et al. Use of resterilized polypropylene mesh in inguinal hernia repair: a prospective, randomized study. J Am Coll Surg 2005; 201:834.
  43. Terzi C, Kiliç D, Unek T, et al. Single-dose oral ciprofloxacin compared with single-dose intravenous cefazolin for prophylaxis in inguinal hernia repair: a controlled randomized clinical study. J Hosp Infect 2005; 60:340.
  44. Rehman S, Khan S, Pervaiz A, Perry EP. Recurrence of inguinal herniae following removal of infected prosthetic meshes: a review of the literature. Hernia 2012; 16:123.
  45. Salvati EA, Chekofsky KM, Brause BD, Wilson PD Jr. Reimplantation in infection: a 12-year experience. Clin Orthop Relat Res 1982; :62.
  46. Agrawal A, Avill R. Mesh migration following repair of inguinal hernia: a case report and review of literature. Hernia 2006; 10:79.