복수가 있는 간경화 환자에서 서혜부 혹? 임상적으로 뚜렷한 탈장, inguinal hernia - 동대문구 답십리, 용답동, 우리안애 우리안愛 내과

https://blog.naver.com/ejercicio/223253699352

상기 환자 이후 **대학교 병원 추적중

아직도 가끔 음주중??..........

보름전부터 혹이 나온다. 우측 (삼각) 팬티 아래 라인

자고 일어나면 괜찮은데..

기침하면 아프고.. 이건 몇일되었다.

육안적으로 관찰함, 서혜부 탈장이며 간경화 추적병원 외과 방문하도록 하였다.

Surgical treatment of abdominal hernias in cirrhotics is often delayed due to the higher morbidity and mortality associated with the underlying liver disease. 간경화 환자의 경우 간질환에 따른 수술의 합병증이나 사망율로 인해 수술적 치료가 미뤄지기도 한다. Some patients are followed conservatively and only operated on when complications occur (“wait and see” approach). 관찰하다가 합병증이 발생해서야 수술을 하기도 한다.

Surgery that does not involve opening the peritoneum may have slightly better outcomes, as the risk of ascitic leak, sepsis and difficult fluid management are reduced. 복막을 열지 않으면 그나마 낫지만 Mortality rates range from 10% in CTP-A patients to 82% in CTP-C patients. The presence of portal hypertension is an important negative predictor, especially in abdominal surgery, as refractory ascites may occur. Careful monitoring in the postoperative period and early intervention of complications are essential. CTP A의 경우 사망율이 10%, CTP C의 경우 82%에 달한다.

; 이 환자의 경우 B이상인데...

Surgical risk in patients with cirrhosis - PubMed (nih.gov )

Previous studies have shown perioperative mortality (수술후 사망율) rates of 10% for CTP A, 30% for CTP B, and 80% for CTP C patients after undergoing abdominal surgery.

The MELD-Na is comprised only of 4 laboratory values (sodium, creatinine, bilirubin, and INR) with a score >26 corresponding to a >90% postoperative mortality rate in 1 study of diverse surgery types.

Assessing the risk of surgery in patients with cirrhosis - PMC (nih.gov )

요즘은 수술 기술의 발달로 과거 위험도 평가의 연관성이 떨어지고 있다

과거 모델에 비해 향상도니 최근의 예측 모델

Given these limitations, if projected risk for an elective surgery is >15% at 90 days, it is generally recommended that a liver transplant evaluation be performed before surgery to determine if that patient is a candidate.

VOCAL-Penn Cirrhosis Surgical Risk Score (vocalpennscore.com )

Elective hernia repair was performed in 57 patients and 189 patients were kept in conservative care, of which 43 (22.7%) developed complications that required emergency hernia repair. Elective surgery provided better five-years survival than conservative care (80% vs. 62%; p = 0.012). Multivariate analysis identified multiples hernias [Hazards Ratio (HR):6.7, p < 0.001] and clinical follow-up group (HR 3.62, p = 0.005) as risk factors for mortality. Among patients undergoing surgical treatment, multivariate analysis revealed MELD>11 (HR 7.8; p = 0.011) and emergency hernia repair (HR 5.35; p = 0.005) as independent risk factors for 30-day mortality. 보존적 관찰보다 수술하는 쪽에서 5년 생존율이 높았다. 재발하거나 그냥 관찰한 경우가 사망의 위험인자였다. 수술한 경우 MELD 가 11을 초과하거나 응급으로 수술한 경우 30일 사망율에 대한 독립적 위험인자가 되었다.

Abdominal hernias in cirrhotic patients: Surgery or conservative treatment? Results of a prospective cohort study in a high volume center: Cohort study - PMC (nih.gov )

Twenty-two patients were included in the study. Fifteen (68.2%) were Child's class B and seven (31.8%) were Child's class C. Hernia repairs were successful without major complications or recurrence in all patients. Minor complications occurred in only three patients, consisting of two hematomas and one case of scrotal swelling. Complications were resolved spontaneously without the need for blood transfusion or reintervention. Thirteen patients died during follow-up (59.1%); eight of these patients died within 1 year after hernia repair. However, there was no 30-day postoperative mortality. Five of the eight patients who died were Child's class B and the remaining three patients were Child's class C. Deaths were all related to cirrhotic complications, and there was no operation-related mortality. B/C에 해당하는 간경화 환자들 사례 보고, 30일 혹은 수술관련 사망자는 없었다고 하며...

Inguinal hernia repair in patients with liver cirrhosis accompanied by ascites - PMC (nih.gov )

Profile of 6352 patients with and without cirrhosis and prognostic factors in hernia repair surgery. 대규모 연구에서는...

Our study was the first to verify a similar prevalence of inguinal hernia in patient with cirrhosis (32.7%) and non-cirrhotic patient (34.1%), demonstrating that the incidence of this type of hernia is not influenced by the presence of ascites. 서혜부 탈장의 발생은 복수와 관련이 없다고 하며 (배꼽 탈장은 더 많지만)

Hernia correction surgery in patient with cirrhosis has a high mortality, especially when performed under urgent conditions associated with the presence of ascites and elevated MELD. 복수가 있고 MELD 점수가 높은 환자에서 응급으로 수술하면 사망율이 높다고 한다.

Cirrhosis and hernia repair in a cohort of 6352 patients in a tertiary hospital: Risk assessment and survival analysis - PMC (nih.gov )