腹腔镜经腹会阴联合Onlay法置入补片预防直肠根治术后远期造口旁疝的疗效  

Clinical application of laparoscopic transabdominal perineum combined with Onlay method to insert patch to prevent long-term parastoma hernia after radical rectal operation

作　　者：任荣 刘文鹏[2] 常亚男 张也 王新波[3] Ren Rong;Liu Wenpeng;Chang Yanan;Zhang Ye;Wang Xinbo(Department of General Surgery and Critical Care Medicine,Zhangjiakou Xuangang Hospital,Zhangjiakou 075100,Hebei Province,China;Department of Hepatobiliary Surgery,Third Hospital of Hebei Medical University,Shijiazhuang 050051,China;Department of General Surgery,Second Affiliated Hospital of Hebei North University,Zhangjiakou 075100,Hebei Province,China)

机构地区：[1]张家口宣钢医院普外科重症医学科,075100 [2]河北医科大学第三医院肝胆外科,石家庄050051 [3]河北北方学院附属第二医院普外科,张家口075100

出　　处：《中华疝和腹壁外科杂志（电子版）》2021年第6期660-663,共4页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

基　　金：河北省重点科技研究计划(20180882)。

摘　　要：目的探究腹腔镜经腹会阴联合Onlay法置入补片预防直肠根治术后远期造口旁疝的临床应用效果。方法选取2016年5月至2018年5月河北北方学院附属第二医院60例直肠根治术患者作为研究对象。所有患者均行腹腔镜经腹会阴根治术。发放随机信封根据单双号分为试验组与对照组(常规乙状结肠造口),每组各30例。试验组应用Onlay法置入补片,对照组给予常规乙状结肠造口。比较2组手术相关指标、排便功能以及术后造口周围疼痛评分与造口孔面积,随访2组术后造口相关并发症发生率及术后1、2、3年造口旁疝的发生率。结果2组患者手术时间、造口时间及术后切口愈合时间差异均无统计学意义(P>0.05),术中出血量试验组少于对照组(P<0.05);试验组患者术后1个月造口周围视觉模拟评估法(VAS)评分低于对照组,术后12个月VAS差异无统计学意义(P>0.05)。试验组患者术后1个月造口孔面积与对照组差异无统计学意义(P>0.05),术后12个月时小于对照组,差异有统计学意义(P<0.05)。试验组排便功能优良率为73.3%,高于对照组46.7%,差异有统计学意义(P<0.05)。2组术后造口相关并发症差异无统计学意义(P>0.05)。试验组术后2、3年造口旁疝发生率均低于对照组,差异有统计学意义(P<0.05)。结论腹腔镜经腹会阴联合Onlay法置入补片安全性高,有利于改善直肠根治术后的排便功能,降低远期造口旁疝的发生率。Objective To explore the clinical application effect of laparoscopic transabdominal perineum combined with Onlay method to prevent long-term parastomal hernia after radical rectal surgery.Methods From May 2016 to May 2018,60 patients undergoing radical rectal surgery in our hospital were selected as the research objects.All patients underwent laparoscopic transabdominal and perineal radical surgery.The patients were divided into experimental group and control group(conventional sigmoidostomy)according to odd and even numbers of random envelopes.30 patients in each group were in the experimental group and the control group were given conventional sigmoidostomy.Comparison of operation-related indicators,defecation function,postoperative pain scores around the stoma and the area of the stoma were compared between the two groups.The incidence of postoperative stoma-related complications and parastomal hernias 1 year,2 years,and 3 years after surgery were followed up in the two groups.Results There was no significant difference in operation time,stoma time and postoperative incision healing time between the two groups of patients(P>0.05).The intraoperative blood loss in the observation group was less than that in the control group(P<0.05),which was statistically significant;observation The VAS score around the stoma in the group was lower than that in the control group at 1 month after the operation,and the difference was not statistically significant at 12 months after operation(P>0.05).After 12 months,it was smaller than the control group,the difference was statistically significant(P<0.05);the observation group had an excellent bowel function rate of 73.3%,which was higher than the control group,and the difference was statistically significant(P<0.05);There was no statistically significant difference in oral-related complications(P>0.05);the incidence of parastomal hernia in the observation group was lower than that in the control group at 2 and 3 years after surgery,and the difference was statistically significant

关 键 词：腹腔镜经腹会阴 ONLAY 补片 直肠根治术 造口旁疝 

分 类 号：R656.2[医药卫生—外科学] R735.37[医药卫生—临床医学]