造口旁疝相关国内外指南和专家共识解读  

Interpretation of domestic and foreign guidelines and consensus related to the diagnosis and treatment of parastomal hernia

作　　者：李航宇[1] 魏士博[1] LI Hang-yu;WEI Shi-bo(Department of General Surgery,the Fourth Affiliated Hospital of China Medical University,Shenyang 110032,China)

机构地区：[1]中国医科大学附属第四医院普通外科,辽宁沈阳110032

出　　处：《中国实用外科杂志》2022年第7期761-764,共4页Chinese Journal of Practical Surgery

基　　金：辽宁省基层卫生计生适宜技术推广项目(No.LHATP-201806);辽宁省重点研发计划指导计划立项项目(No.2017225006)。

摘　　要：由于造口旁疝在诊治过程中存在的争议较多,我国腹壁疝相关指南中缺乏对造口旁疝的系统性阐述,检索国内外与造口旁疝诊治相关的指南或共识,并对其中提出的共性和个性问题进行分析:(1)在造口旁疝发生率方面,造口术后不同随访时间的累积发生率更有临床价值。(2)造口旁疝合并无法解除的肠梗阻或肠绞窄时需要行急诊手术,而择期手术则需要有经验的医生根据病人的具体情况个体化制定治疗方案,须全面评估风险和收益。(3)在临床诊疗过程中应注重结合病人的具体情况,巧妙运用各术式独特优势,选择适合病人的治疗方案。Sugarbaker、Keyhole和Sandwich 3种术式各有优缺点,目前临床中Sugarbaker手术相对开展较多,复发率低。(4)推荐造口手术预防性使用不可吸收补片。Due to many controversies in the diagnosis and treatment of parastomal hernia, there is a lack of systematic description of parastomal hernia in the relevant guidelines of abdominal wall hernia in China. The guidelines or consensus related to the diagnosis and treatment of parastomal hernia at home and abroad were retrieved, and the common and individual problems proposed in them were analyzed:(1) In terms of the incidence of parastomal hernia, the cumulative incidence of different follow-up times after ostomy is more clinically valuable.(2) Parastomal hernia combined with unresolved intestinal obstruction or strangulation requires emergency surgery, while elective surgery requires experienced doctors to make personalized treatment plans according to the specific conditions of the patient, and a comprehensive assessment of risks and benefits is required.(3) In the process of clinical diagnosis and treatment, attention should be paid to the specific situation of the patient, clever use of the unique advantages of each surgical method, and selection of a treatment plan suitable for the patient.Sugarbaker, Keyhole and Sandwich have their own advantages and disadvantages. At present, Sugarbaker is relatively more developed in clinical practice, and the recurrence rate is low.(4) Prophylactic use of non-absorbable meshes in colostomy is recommended.

关 键 词：造口旁疝 手术时机 个体化 肠管蠕动 预防 

分 类 号：R6[医药卫生—外科学]