Clinical Study On The Risk Factors Of Incarcerated Hernia Progression As Strangulated Hernia

BackgroundHernia is a commonly and frequently occurring disease in general surgery.If not treated in time,it can develop into incarcerated hernia.If not still treated in time,incarcerated hernia can further deteriorate and develop into strangulated hernia.Strangulated hernia is prone to tissue necrosis,and its treatment not only requires additional resection of necrotic bowel or omentum,but also may lead to secondary local and systemic infection,which ultimately endangers life.At present,it is not difficult to diagnose incarcerated hernia clinically,but there is no clear diagnostic standard for strangulated hernia.Incarceration time is undoubtedly the main factor leading to strangulation hernia,but the specific prediction of strangulation time has not been determined,and whether other factors,such as age,hernia type,preoperative laboratory indicators,etc.have predictive value for strangulation hernia is worth further study.ObjectiveIn the First Affiliated Hospital of Shantou University Medical College emergency admitted in recent 11 years incarcerated hernia cases related clinical data were retrospectively analyzed,aimed to explore the related progress of incarcerated hernia hernial strangulation risk factors,and evaluate its clinical value in predicting strangulated hernia,for the more reasonable decision reference for the treatment of incarcerated hernia.MethodsVarious types of incarcerated hernia cases treated by emergency surgery in the First Affiliated Hospital of Shantou University Medical College from January 2011 to March2022 were selected as the objects of this study,and the selected clinical data were collected,sorted out and analyzed.The patients were divided into two groups,namely incarcerated hernia group and strangulated hernia group,according to whether there was tissue necrosis and resection of necrotic tissue(including omentum greater and intestine,etc.)during intraoperative exploration.Clinical data of the two groups were collected respectively.Including hernia type,incarceration time(H),age(Y),WBC,NE%,NE#,LY%,LY#,NLR,MO%,EO%,EO#,RDW＿SD,PLT,PT,PT%,PTR,PT INR,APTT,Fib,K,Na,Ca,GLU,Cr and BUN.Then,statistical methods were used to analyze the relationship between each index and strangulated hernia,and finally,the clinical value of the index in predicting strangulated hernia was evaluated by receiver operating characteristic(ROC)curve.ResultsA total of 179 patients were included in this study,including 135 cases(75.4%)in the simple incarcerated hernia group.44 cases(24.6%)were strangulated hernia group.Sixteen differences were obtained by univariate analysis,including hernia type,incarceration time,age,NE%,NE#,LY%,LY#,NLR,EO%,EO#,PLT,Fib,Ca,GLU,Cr and BUN.The strangulation hernia group had the most oblique hernia and the strangulation rate of internal hernia was the highest.Incarceration time,age,NE%,NE#,NLR,Fib,GLU,Cr,BUN were positively correlated with strangulation hernia.LY%,LY#,EO%,EO#,PLT,Ca were negatively correlated with strangulation hernia.By multiple factors analysis we won six incarcerated hernia progress for strangulated hernia independent factors,types and incarcerated hernia time,age,LY %,PLT and Fib,among them,the time for internal hernias and incarcerated hernia type,the rise of Fib and strangulated hernia were positively correlated relationship,is a risk factor for strangulated hernia occurs,that is to say,When incarcerated hernia was internal hernia,the possibility of strangulation hernia increased with the extension of incarceration time and the increase of Fib.The increase of age,LY% and PLT is negatively correlated with the occurrence of strangulated hernia,which is a protective factor for the occurrence of strangulated hernia.In other words,the possibility of occurrence of strangulated hernia decreases with the increase of age,LY% and PLT.ROC curve analysis showed that the areas under the curve were incarceration time,Fib,LY%,PLT and age from large to small.The incarceration time with the largest area under the curve was taken as the best prediction index.When the Yolden index reached its maximum,its corresponding cut-off value was 11.5,that is,incarceration time over 11.5h was the best prediction index for strangulation hernia.ConclusionThrough to the group of incarcerated hernia cases selected by the comparative analysis,we found that the time for internal hernias and incarcerated hernia type,the rise of Fib and strangulated hernia were positively correlated relationship,are independent risk factors for the development of strangulated hernia occurs,that is,when the incarcerated hernia is internal hernias and longer duration of incarcerated,Fib,possibility of strangulated hernia increased;The increase of age,LY% and PLT was negatively correlated with the occurrence of strangulated hernia,which was an independent protective factor for the occurrence of strangulated hernia.In other words,the possibility of occurrence of strangulated hernia decreased with the increase of age,LY% and PLT.After a series of analysis and calculation,we finally determined that incarceration time over 11.5h was the best predictor of strangulated hernia,that is,when incarceration time was over 11.5h,we highly suspected that incarcerated hernia had developed into strangulated hernia.