Bacteria in hernia sac: an important risk fact for surgical site infection after incarcerated hernia repair
Bacteria in hernia sac: an important risk fact for surgical site infection after incarcerated hernia repair
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DOI：
10.1007/s10029-014-1275-z
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发表时间：
2015-04-01
期刊：
影响因子：
2.3
通讯作者：
Wang, J.
中科院分区：
文献类型：
--
作者：
Yang, L.;Wang, H.;Wang, J.
尽管最近的一些报告证明嵌顿和/或绞窄性疝不是补片修复的禁忌症，但由于术后手术部位感染（SSI）率增加，仍然存在普遍担忧。本临床研究的目的是评估嵌顿疝修补术后增加 SSI 风险的因素，并确定与 SSI 相关的病原体。对 2007 年 1 月至 2011 年 12 月的 4 年时间间隔内前瞻性收集的数据进行回顾性分析。总共分析了 121 例接受嵌顿疝急诊手术的患者。其中 107 例采用网片修复，14 例采用初次缝合修复。 121 名患者中有 9 名观察到 SSI。在研究的 15 个术前和术中变量中，症状持续时间、糖尿病、肠梗阻、肠切除或网片修复、疝囊中存在的细菌和疝囊中的浑浊液体被发现是预测 SSI 的重要因素。在多变量分析中，只有肠切除、症状持续时间和疝囊中存在的细菌是自变量。在疝囊中发现并通过伤口引流或拭子培养的最常见病原体是大肠杆菌。 9 名患者中有 6 名从伤口引流液或拭子中培养的细菌菌株与从疝囊液体中培养的菌株相同。肠道来源的大肠杆菌是与嵌顿疝修补术后 SSI 相关的重要常见微生物。当未进行肠切除、症状持续时间小于24小时且液体疝囊清晰时，可以使用假体补片。
Although some recent reports have proven that incarcerated and/or strangulated hernia is not contraindication to mesh repair, there is still a common concern owing to increased rate of postoperative surgical site infection (SSI). The aim of this clinical study was to evaluate factors that increase the risk of SSI after incarcerated hernia repair, and to identify the pathogens related to SSI.A retrospective analysis was performed on data collected prospectively over a 4-year interval from January 2007 to December 2011. A total of 121 patients who underwent emergency surgery for incarcerated hernias were analyzed.107 hernias were repaired using mesh versus 14 primary suture repairs. SSIs were observed in 9 of the 121 patients. Of 15 preoperative and intraoperative variables studied, duration of symptoms, diabetes mellitus, present of ileus, bowel resection or mesh repair performed, bacteria present in hernia sac and cloudy fluid in hernia sac were found to be significant factors predicting SSI. On multivariate analysis only bowel resection, duration of symptoms and bacteria present in hernia sac were independent variables. The most common pathogen found in hernia sac and cultured from wound drainage or swab was Escherichia coli. The strains of bacteria cultured from wound drainage or swab were same as those cultured from fluid in hernia sac in six of nine patients.Gut-sourced E. coli is an important common organisms associated with SSI after incarcerated hernia repair. Prosthetic mesh could be used when no bowel resection is performed, duration of symptoms less than 24 h and fluid hernia sac is clear.