腹腔镜手术治疗造口旁疝的共识与争议  

Consensus and controversy of laparoscopic surgery for parastomal hernia

作　　者：乐飞[1] 李健文[1] YUE Fei;LI Jian-wen(General Surgery,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院普外科,上海200025

出　　处：《中国实用外科杂志》2022年第7期737-742,共6页Chinese Journal of Practical Surgery

基　　金：上海市2020年度“科技创新行动计划”生物医药领域科技支撑专项(No.20S31907600)。

摘　　要：造口旁疝治疗较为复杂,总体疗效不如腹壁切口疝。腹腔镜手术治疗造口旁疝有较多的获益,但目前难以形成适用于所有病人和所有医师的临床解决方案。早期Keyhole手术开展较多,近年来Sugarbaker手术开展比例增高。现有“弱证据”指向的初步共识是Sugarbaker优于Keyhole,但在修补材料有待改进的情况下,Sugarbaker替代Keyhole尚为时过早,二者均有各自的临床适应证。腹腔镜修补结合造口原位重建技术在恢复造口功能等方面取得了非常好的效果。对于无明显重建指征的造口旁疝,也可在全腹腔镜下游离肠管、关闭缺损、缩小疝囊,既可将感染、造口相关并发症等风险降至最低,又可获得满意的疗效。近年来,各类腔镜腹膜外修补技术(EER)逐渐兴起,在造口旁疝领域,EER目前处于探索阶段,适应证有限。由于高质量、多中心、大样本RCT的匮乏,临床决策推荐尚缺乏高级别的证据支持,腹腔镜造口旁疝修补手术的术式选择争议还将持续。随着更多高质量文献的发表,相信外科医师一定能够在共识中解决争议,在争议后达成共识,为造口旁疝病人提供最佳的微创治疗策略。It is more complicated to treat parastomal hernia,and the overall outcome is less satisfactory than that of ventral and incisional hernia. Laparoscopic treatment of parastomal hernias has multiple advantages. Nevertheless, it is not a universal solution for all patients or surgeons. The Keyhole technique dominated in the early stage. The Sugarbaker technique has an increasing proportion in recent years. The preliminary consensus recommends that Sugarbaker is better than Keyhole based on the existing“low”quality of evidence.However, it is premature to replace Keyhole with Sugarbaker considering material improvements. Both techniques have their clinical indications, respectively. Laparoscopic repair combined with in situ re-ostomy has achieved good outcomes in restoring stoma function. For those without obvious indications for stoma reconstruction, total laparoscopy could mobilize stomal loops, close the defects, and reduce hernia sacs with minimized risks of infection and stoma-related complications, as well as satisfactory outcomes. Recently,various endoscopic extraperitoneal repair(EER) techniques have gradually emerged. In the field of parastomal hernia repair, it is still in the exploratory stage, with limited indications. Due to the lack of high-quality, multicenter,large-sample RCT research, clinical recommendations still require the support of high-level evidence. The controversies of laparoscopic procedure selection for parastomal hernia repair will continue. With the publication of more high-quality literature, controversies are believed to be solved to reach a consensus, providing the optimal minimally invasive therapeutic strategy for patients with parastomal hernia.

关 键 词：造口旁疝 腹腔镜 Keyhole手术 Sugarbaker手术 Lap-re-do手术 腹膜外 

分 类 号：R6[医药卫生—外科学]