从腹壁结构和生物力学分析造口旁疝的发生与发展  

Analysis of the occurrence and development of parastomal hernia from the structure and biomechanics of abdominal wall

作　　者：陈双[1] 王辉[2] 吴丁财[3] CHEN Shuang;WANG Hui;WU Ding-cai(Department of Gastroenterological Surgery and Hernia Center,the Sixth Affiliated Hospital of Sun Yatsen University,Guangzhou,510655,China;不详)

机构地区：[1]中山大学附属第六医院胃肠、疝和腹壁外科,广州510655 [2]中山大学附属第六医院结直肠外科,广州510655 [3]中山大学化学院,广东广州510275

出　　处：《中国实用外科杂志》2022年第7期743-747,共5页Chinese Journal of Practical Surgery

基　　金：国家重点研发计划(No.2021YFC2101700);广东省基础与应用基础研究联合基金(No.20202011050000094)。

摘　　要：造口旁疝是肠造口术后最常见的并发症之一。正常的腹壁是左右对称的结构,构成了相对密闭且压力均衡的腹腔,而造口打破了这种对称和平衡。同时,在造口肠管自身运动以及腹壁力学特性的影响下,造口旁疝的发生似乎无法避免,而发生的时间则取决于造口对“腹壁功能单位”的破坏与“腹壁功能单位”代偿协调之间的平衡。造口旁疝的有效预防需要重视腹壁造口的规范性,尤其是造口的位置,以及造口肠管穿越腹壁的斜度。因为造口旁疝一旦形成,势必逐渐进展,并出现临床症状和体征。对于造口旁疝的治疗,腹腔镜手术具有明显的优势,尤其是Sugarbaker手术,从手术原理以及腹壁力学特性角度考量,均优于Kehole手术,这点在术后复发率上也可以获得验证。Parastomal hernia is one of the most common complications after enterostomy. The normal abdominal wall is a symmetrical structure,forming a relatively closed and pressure-balanced abdominal cavity,and the stoma breaks this symmetry and balance. At the same time,under the influence of the movement of the colon and the mechanical characteristics of the abdominal wall,the occurrence of parastomal hernia seems inevitable. Sooner or later,it depends on the balance between the damage of the stoma to "abdominal functional unit" and the compensation and coordination of "abdominal functional unit". To prevent parastomal hernia,we need to pay attention to the stoma on the abdominal wall,especially the position of the stoma and the inclination of the stomal bowel through the abdominal wall. Because once the initial stomal hernia is formed,it is only a matter of time before it develops into a parastomal hernia with clinical symptoms and signs. For treatment of parastomal hernia,endoscopic surgery has significant advantages,particularly the Sugarbaker,which is superior to Kehole in terms of surgical principles and mechanical properties of the abdominal wall,as demonstrated by postoperative recurrence rates.

关 键 词：造口旁疝 腹壁 生物力学 黏弹性 各向异性 

分 类 号：R6[医药卫生—外科学]