改良Sublay-Keyhole技术原位修补造口旁疝  

REPAIR IN SITU OF PARASTOMAL HERNIA WITH MODIFIED Sublay-Keyhole TECHNIQUE

作　　者：费阳[1] 李基业[1] 姚胜[1] 

机构地区：[1]解放军总医院第一附属医院疝和腹壁外科治疗研究中心,北京100048

出　　处：《中国修复重建外科杂志》2011年第9期1067-1070,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨改良Sublay-Keyhole技术原位修补造口旁疝的方法及疗效。方法 2007年10月-2010年3月,采用改良Sublay-Keyhole技术原位修补造口旁疝11例。男5例,女6例;年龄55～72岁,平均63岁。体重指数为23.5～32.5,平均28.2。患者均为永久性造瘘,其中6例为低位直肠癌行Miles术式后的乙状结肠末端造瘘,2例为溃疡性结肠炎行全结肠切除术后的回肠末端造瘘,3例为膀胱癌行回肠代膀胱术后的回肠末端造瘘。1例患者既往曾行聚丙烯补片修补后复发。末次手术至该次入院时间为1～4.5年,平均2.5年。根据George Eliot医院分类标准:2b级3例,3a级2例,3b级5例,4级1例。疝环最长径为6～12cm,平均9.5cm。结果 11例均以改良Sublay-Keyhole技术成功完成腹壁重建手术。术中测量疝环面积为30～112cm2,平均75.5cm2;应用聚丙烯补片面积为175～360cm2,平均280.5cm2。手术时间120～195min,平均165min;术后住院时间9～14d,平均11d。术后患者切口均Ⅰ期愈合,无腹壁感染发生。2例(18.2%)发生血清肿,1例(9.1%)发生腹壁血肿,对症处理后愈合。11例均获随访,随访时间10～39个月,平均26.3个月。1例(9.1%)于术后11个月造口旁疝复发,再次修补手术时发现疝环关闭处缝线松脱同时补片孔洞过于宽大,予以缝合缩窄后随访15个月无复发;其余10例患者术后未见造口旁疝复发或发生其他切口疝。结论改良Sublay-Keyhole技术是造口旁疝患者腹壁重建的有效方法,具有复发率低、并发症少等优点,但远期疗效需进一步观察随访。Objective To investigate the procedure and the effectiveness of modified Sublay-Keyhole technique for repair in situ of parastomal hernia.Methods Between October 2007 and March 2010,11 patients with parastomal hernia underwent modified Sublay-Keyhole technique for repair in situ.There were 5 males and 6 females with an average age of 63 years（range,55-72 years）.The average body mass index was 28.2（range,23.5-32.5）.All stomas in patients were permanent,including 6 end colostomies caused by abdominal perineal resection for rectal cancer,2 end ileostomies secondary to total colon resection for ulcerative colitis,and 3 end ileostomies following ileal conduit for bladder resection.One patient underwent previous prothetic repair with polypropylene mesh.The average time from last operation to admission was 2.5 years（range,1-4.5 years）.According to classification criteria of George Eliot hospital,3 cases were classified as grade 2b,2 as grade 3a,5 as grade 3b,and 1 as grade 4.The average longest diameter of hernia ring was 9.5 cm（range,6-12 cm）.Results Reconstructions of abdominal wall in all patients were performed successfully through modified Sublay-Keyhole technique.The average size of hernia ring was 75.5 cm2（range,30-112 cm2）,and the average size of polypropylene mesh was 280.5 cm2（range,175-360 cm2）.The average operative time was 165 minutes（range,120-195 minutes） and the average postoperative hospitalization days were 11 days（range,9-14 days）.All patients achieved healing of incision by first intention with no abdominal wall infection.Seroma and hematoma occurred in 2 patients and 1 patient,respectively,and were cured by needle aspiration and pressure bandaging.All patients were followed up 26.3 months on average（range,10-39 months）.One case suffered from parastomal hernia recurrence at 11 months postoperatively because of suture loosening and too wide aperture in mesh;and re-sutures in both mesh aperture and myofascial dehiscence were given and no recurrence was observed durin

关 键 词：Sublay-Keyhole技术 原位修补 造口旁疝 腹壁重建 

分 类 号：R656.2[医药卫生—外科学]