腹腔镜造口旁疝造口重建下Keyhole修补与非重建下Keyhole修补的临床对照研究  

A clinical comparative study of Keyhole with re-ostomy and without re-ostomy in the treatment of laparoscopic parastomal hernia repair for stoma hernia

作　　者：路夷平[1] 叶晋生[1] 于淼[1] 贺志坚[1] 梁燕凯 张洪海[1] 王啸飞[1] 高建新[1] 

机构地区：[1]首都医科大学附属北京中医医院肿瘤外科,北京100010

出　　处：《中华普通外科杂志》2017年第12期992-996,共5页Chinese Journal of General Surgery

摘　　要：目的通过腹腔镜造口旁疝造口重建下Keyhole修补术与非重建下Keyhole修补术的比较，分析重建造口术式在治疗造口旁疝中的优势．并总结重建造口手术术式的关键技术要点。方法2010年1月至2016年12月，120例造口旁疝患者中68例行腹腔镜造口重建下Keyhole修补术，52例行腹腔镜非重建Keyhole修补术式，比较术前、术中及术后相关指标。结果造口重建组和非重建组比较，造1：3重建组造口肠管肠瘘发生率（χ^2=5．411，P=0．033）、补片感染（χ^2=6．823，P=0．014）、术后浆液肿和血清肿发生率（χ^2=14．266，P〈0．001）、术后复发（χ^2=8．688，P=0．005）、术后外观不满意情况（χ^2=9．479，P=0．004）均显著低于非重建组，差异有统计学意义。结论造口重建造121旁疝补片修补术可以显著降低肠管肠瘘、补片感染和浆液肿和血清肿的发生，减少术后复发。Objective To compare laparoscopic Keyhole parastomal hernia repair with re-ostomy technique or without re-ostomy in the treatment of stoma hernia, then analyze the advantages of reconstruction ostomy, and summarize the key technical points of the reconstruction operation. Methods From Jan 2010 to Dec 2016, 68 stoma hernia patients underwent laparoscopic Keyhole parastomal hernia repair with reostomy technique, 52 patients underwent laparoseopic Keyhole parastomal hernia repair without re-ostomy technique. The preoperative, intraoperative and postoperative parameters were analyzed. Results Compared to without re-ostomy group, the re-ostomy reconstruction group had low incidence rate of intestinal fistula （χ^2 = 5. 411, P = 0. 033）, patch infection （χ^2 = 6. 823, P = 0. 014）, the incidence of postoperative serous swelling and serum swelling （χ^2= 14. 266, P 〈 0. 001 ）, postoperative recurrence （χ^2 = 8. 688, P = 0.005 ） and postoperative appearance dissatisfaction （χ^2 = 9. 479, P = 0.004 ） . Conclusion Laparoscopic parastomal hernia repair and re-ostomy technique reduces the incidence rate of intestinal fistula, patch infection and serous swelling and serum swelling, decreases the postoperative recurrence rate and appearance dissatisfaction.

关 键 词：造口术 疝 腹部 Keyhole术式 

分 类 号：R656.2[医药卫生—外科学]