复杂性造口旁疝18例外科治疗策略分析  

Surgical management for complicated parastomal hernia:A report of 18 cases

作　　者：任峰[1] 周静瑜 周建平[1] REN Feng;ZHOU Jing-yu;ZHOU Jian-ping(Department of Geriatrics Surgery,the Second Xiangya Hospital of Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院普外老年外科,湖南长沙410011

出　　处：《中国实用外科杂志》2021年第4期412-414,共3页Chinese Journal of Practical Surgery

摘　　要：目的分析复杂性造口旁疝的外科处理策略。方法回顾性分析2015年12月至2020年2月中南大学湘雅二医院普外老年外科收治的复杂性造口旁疝18例临床资料,其中可还纳Hartmann术后造口旁疝7例(合并切口疝1例)、巨大切口疝合并造口旁疝2例、造口局部情况特殊7例(包括肿瘤种植转移2例、造口变形等需要整形5例)、复发性造口旁疝2例。分别行造口关闭术、造口移位术、腹腔镜疝修补术,随访观察治疗效果。结果所有病例均达到预期治疗效果,7例Hartmann术后可还纳的病人均未发生吻合口漏。共6例病人出现术后并发症,其中2例发生血清肿,1例合并巨大切口疝造口关闭病人出现皮瓣坏死伤口裂开,2例发生伤口感染,1例造口周边软组织感染,经引流、真空辅助闭合(VAC)或换药治愈。随访26(6~58)个月,4例失访,随访率为77.8%,未发现造口旁疝或腹壁疝复发。结论复杂性造口旁疝应遵循"能关则关、能补则补、移位为辅"的治疗策略,针对具体病情设计精准的个体化治疗方案。Objective To analyzed the surgical management of some complicated parastomal hernia.Methods The clinical data of 18 patients with complicated parastomal hernia treated between December 2015 and February 2020 in Department of Geriatrics Surgery,the Second Xiangya Hospital of Central South University were analyzed retrospectively.There were 7 cases of parastomal hernia(including 1 case of incision hernia),2 cases of huge incision hernia combined with parastomal hernia,7 cases of special local conditions of stoma(including 2 cases of tumor metastasis,5 cases of stoma deformation,etc.)and 2 cases of recurrent parastomal hernia.The therapeutic effect was followed up.Results The expected therapeutic effect had been achieved for all cases.No anastomotic leakage occurred in the 7 patients undergoing colostomy reversal surgery.Postoperative complications were observed in 6 patients including 2 cases of seroma,1 case of flap necrosis,2 cases of wound infection,and 1 case of soft tissue infection around the stoma.All of the above complications were cured by wound dressing,drainage or VAC.No recurrence of hernia was found with the follow-up rate of 77.8%(range 6 to 58 months).Conclusion Complicated parastoma hernias should follow the treatment strategy of combination of stoma closure,repair and displacement.Individual treatment plan should be designed according to different condition for complicated parastomal hernia.

关 键 词：造口旁疝 HARTMANN术 切口疝 腹腔镜 疝修补术 

分 类 号：R6[医药卫生—外科学]