鼠径ヘルニア術後創感染の検討と対策 [in Japanese] INVESTIGATION OF AND MEASURES AGAINST WOUND INFECTION FOLLOWING SURGERY FOR INGUINAL HERNIA [in Japanese]
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鼠径ヘルニア術後の創感染例に関しての検討を行った.当院では鼠径ヘルニアに対し局所麻酔でのMesh Plug法(以下MP) を第一選択の術式としており現在までに1,310例に施行した.この1,310例を対象とし検討を行ったところ, 6例 (0.46%) に術後感染を認め, 2例でprosthesis除去を要した.感染の頻度は両側同時手術例で有意に多かった (P<0.001). prosthesis除去を要した2例はいずれも遅発感染例で, prosthesis除去にいたるまでに非常に長期間の保存的治療が行われていた.一方prosthesis除去を要しなかった4例は比較的術後早期に感染を発症しており,感染発症から創の改善が認められるまでの期間は30日以内であった.以上より保存的治療にて30日以内に改善傾向のない例や遅発感染例ではprosthesis除去を要すると考えられた.また両側同時手術例では感染予防が重要な問題であると考えられた.
A clinical investigation was made on cases of surgical wound infection following surgery for inguinal hernia. In our hospital we have employed Mesh Plug method (MP) under local anesthesia as the first choice for inguinal hernia repair, and performed MP in a total of 1310 cases up to now. These 1310 cases were enrolled in this clinical study. Postoperative infection was noted in six (0.46%) cases, in two of which removal of the prosthesis was required. A significantly higher frequency of infection was noted in cases where surgery was performed for bilateral inguinal hernias simultaneously (p<0.001). The two cases required the removal of the prosthesis were of delayed onset of infection, in which conservative therapy for a very long time was performed until the removal. On the other hand, in the remaining four cases demanding no removal, infection occurred relatively early after the surgery and the period from the onset of the infection up to improvement of the surgical wound was less than 30 days. From these findings, we consider that the removal of the prosthesis may be required in cases in which no signs of improvement are shown by conservative therapy within 30 days or in cases of delayed onset of infection. Further the prevention of postoperative infection may become a serious problem in cases undergoing simultaneous operation for bilateral lesions.
- The journal of the Japanese Practical Surgeon Society
The journal of the Japanese Practical Surgeon Society 67(11), 2544-2548, 2006-11-25
Japan Surgical Association