男性成人患者單側腹股溝疝氣修補後對側疝氣發作的危險因子:中部某醫院10年追蹤研究

目的：台灣每年大約有四萬名成年男性病患接受腹股溝疝氣修補手術。然而單側腹股溝疝氣在手術治療後，部分病患會發生對側腹股溝疝氣發作的情形。隨著微創疝氣手術的普及化，在不增加手術傷口的前提下，同時做對側腹股溝疝氣修補成為一個可行的選項。然而例行性的對側修補並非適合所有病人，所以若可找出對側腹股溝疝氣發作的危險因子，能幫助患者於首次疝氣手術時決定是否同時進行對側修補。方法：回溯性收集某區域醫院從2012年至2021年接受腹股溝疝氣手術病患資料，並辨識兩側於不同時間接受手術之患者為個案組。探討病患基本資料及共病症與對側腹股溝疝氣發作之關聯性。結果：本研究共收案731位患者，其中40位病患在追蹤期間內接受對側腹股溝疝氣修補手術，對側疝氣發作接受手術比率為5.5%。兩次疝氣手術間隔時間平均為35.53個月，間隔時間中位數為28.50個月。多元羅吉斯迴歸分析初次接受左側疝氣手術比起右側的勝算比為2.401，p值為0.012。有前列腺疾病的患者比起無前列腺疾病的勝算比為3.338，p值為0.002。結論：初次接受左側疝氣手術或有前列腺疾病為後續對側腹股溝疝氣接受手術之危險因子。若單側腹股溝疝氣患者有以上其中一樣危險因子，在被告知手術併發症知風險後，可考慮於當次手術同時接受對側腹股溝預防性疝氣修補。

關鍵字

腹股溝疝氣；對側腹股溝疝氣；危險因子

並列摘要

Purpose: Approximately 40,000 adult males in Taiwan undergo inguinal hernia repair surgery each year. However, after undergoing surgical treatment for unilateral inguinal hernia, some patients may experience an occurrence of contralateral inguinal hernia. With the increasing popularity of minimally invasive hernia surgery, simultaneous repair of the contralateral inguinal hernia without increasing the surgical incision has become a viable option. However, routine contralateral repair is not suitable for all patients. Therefore, identifying the risk factors for contralateral inguinal hernia occurrence can help patients decide whether to undergo simultaneous repair during the initial hernia surgery. Methods: Retrospective collection of patients who underwent inguinal hernia surgery in a hospital from 2012 to 2021 was conducted, and patients who underwent surgery on both sides at different times were identified as the experimental group. The study aimed to investigate the association between patient demographics, comorbidities, and the occurrence of contralateral inguinal hernia. Results: A total of 731 patients were included in this study, among whom 40 patients underwent contralateral inguinal hernia repair surgery during the follow-up period, resulting in 5.5% of contralateral hernia occurrence. The mean interval between hernia occurrences requiring surgery was 35.53 months, with a median interval of 28.50 months. Multiple logistic regression analysis showed that the odds ratio for initially undergoing left-sided hernia surgery compared to right-sided surgery was 2.401, with a p-value of 0.012. Patients with prostate disease had an odds ratio of 3.338 compared to those without prostate disease, with a p-value of 0.002. conclusion: The initial left-sided hernia surgery and the presence of prostate disease are risk factors for metachronous contralateral inguinal hernia requiring surgery. If a unilateral inguinal hernia patient has either of these risk factors, and after being informed about the risks of surgical complications, it may be considered to undergo simultaneous prophylactic repair of the contralateral inguinal hernia.