腹腔镜造口重做造口旁疝补片修补术的手术效果及安全性评估  

Evaluation of the effectiveness and safety of the laparoscopic parastomal hernia repair and re-ostomy technique

作　　者：何凯[1,2] 姚琪远[1,2] 陈浩[1,2] 丁锐[1,2] 花荣[1,2] 颜晓捷[1,2] 武振[1,2] 

机构地区：[1]复旦大学疝病中心 [2]复旦大学附属华山医院普外科,上海200040

出　　处：《外科理论与实践》2010年第6期616-619,共4页Journal of Surgery Concepts & Practice

基　　金：国家自然科学基金(30872533)

摘　　要：目的:探讨运用造口重做法进行造口旁疝补片修补术的手术效果及手术安全性。方法:2009年5月至2010年8月,共对12例结肠造口旁疝病人运用IPST补片进行造口重做腹腔镜造口旁疝补片修补手术,包括10例腹腔镜修补术式和2例单孔腹腔镜修补术式。术后采用定期电话询问及门诊检查相结合的方法进行随访;随访内容包括:电话询问饮食,有无腹痛,排气、排便情况及造口情况;门诊进行腹部和造口检查及CT平扫。结果:12例手术均获成功,手术时间80～170 min,平均112 min;术后住院时间3～8 d,平均6 d;术后随访1～16个月,平均6个月。随访结果显示均未见复发;所有病例未见明显浆液肿和血清肿的发生;未发生与补片、手术相关的感染;无顽固性疼痛发生。修补区暂时性腹壁疼痛3例,均于术后4周内缓解。术后排气时间1～4 d,平均2 d,术后暂时性腹胀4例,术后排便不适、不畅4例;但均未发生因造口并发的肠梗阻。结论:运用IPST补片进行造口重做的腹腔镜造口旁疝补片修补术,手术技术上安全、可行,随访结果显示疗效较好,值得在临床推广应用。Objective To evaluate the effectiveness and safety of laparoscopic parastomal hernia repair and re-ostomy with Dynamesh-IPST mesh.Methods Laparoscopic parastomal hernia repair and re-ostomy with Dynamesh-IPST mesh were performed on 12 patients from May 2009 to August 2010,including 10 laparoscopic operations and 2 SILS procedures.The post-operative follow-up includes telephone inquiry which involves diet,abdominal symptoms,defecation,stoma condition,physical examination and CT scanning for the 12 patients.Results All the 12 operations were successful without conversion to open herniorraphy.The operating time ranged from 80 to 170 min（mean 112 min）.The length of postoperative hospital stay ranged from 3 to 8 d（mean 6 d）.The post-operative follow-ups ranged from 1 to 16 months（mean 6 months）.There was no recurrence,no post-operative persistent painfulness,no obvious seroma and no mesh-related infection in the series,while 3 patients complained of painfulness around the operative field;4 patients had temporary abdominal distention;4 patients had concomitant defection disorders;the patients were treated according to the symptoms and had well recovered.Conclusions Laparoscopic parastomal hernia repair and re-ostomy technique is feasible,safe,and effective.

关 键 词：造口旁疝 造口术 腹腔镜 无张力疝修补术 

分 类 号：R656.2[医药卫生—外科学]