新型Dual Lap修补手术治疗成人复杂造口旁疝的临床研究  

Therapeutic effect of a new hybrid technique for parastomal hernia repair

作　　者：罗文[1] 王勇[1] 段鑫[1] 石念 武英翔 杜晨阳 Luo Wen;Wang Yong;Duan Xin;Shi Nian;Wu Yingxiang;Du Chenyang(Department of Hernia and Abdominal Wall Surgerg,Central Municipal Hospital,Affiliated Tongji Medical College,Huazhong University of Science&Technology,Hubei Wuhan 430014,China)

机构地区：[1]华中科技大学同济医学院附属武汉中心医院疝与腹壁外科,湖北武汉430014

出　　处：《腹部外科》2023年第1期60-63,共4页Journal of Abdominal Surgery

基　　金：湖北省卫生健康委员会联合基金项目(WJ2019H382);武汉市医学科研项目青年重点项目(WX19Q35)。

摘　　要：目的探讨新型腹腔镜联合开腹杂交手术修补方法(Dual Lap)治疗成人复杂造口旁疝的可行性和临床疗效。方法回顾性分析2015年1月至2021年1月期间,采用开腹经腹壁修补和腹腔镜修补相结合的杂交手术修补方式(即Dual Lap术式)治疗的21例成人复杂造口旁疝临床资料。其中男性16例,女性5例;年龄(63.6±5.2)岁(51~78岁);其中膀胱癌术后回肠代膀胱造口病人3例,结直肠癌术后结肠造口病人15例,溃疡性结肠炎全结肠切除术后永久性回肠造口病人2例,家族性结肠息肉病全结肠切除术后永久性回肠造口病人1例;嵌顿性造口旁疝6例,复发造口旁疝4例,合并腹壁切口疝11例。结果21例病人Dual Lap杂交修补手术均顺利完成,术中探查造口旁疝疝环直径为(6.8±1.7)cm(3~15 cm),切口疝疝环直径为(4.8±1.3)cm(3~7 cm),手术修补时间为(100.7±21.5)min(90~140 min);术中无肾脏、输尿管及肠管损伤;术后72 h内疼痛需使用镇痛剂辅助治疗的病人8例,使用时间3 d;术后住院时间为(8.1±2.7)d(7~13 d);术后7 d时所有病人均未见肠梗阻、肠漏、局部血肿及伤口感染发生,术后伤口脂肪液化2例,经换药处理后愈合。术后随访时间为(11.6±4.2)个月(12~48个月),所有病人均获随访,术后均未见肠梗阻,未见造口疝及切口疝复发,未见造口肠管脱垂、慢性疼痛及补片感染发生。结论新型Dual Lap术式是治疗成人复杂造口旁疝的一种安全、有效的手术方式,值得临床应用。Objective To explore the etiology and repairing of parastomal hernia and examine the feasibility and clinical efficacy of a new laparoscopic plus open hybrid repairing(Dual Lap)for adult complicated parastomal hernia.Methods A retrospective analysis of clinical data was performed for 21 adult patients with complicated incarcerated parastomal hernia undergoing Dual Lap,a hybrid surgery of combining laparoscopic and open transabdominal wall repairing from January 2015 to January 2021.There were 16 males and 5 females with an average age of(63.6±5.2)(51-78)years.There were ileal cystostomy after bladder cancer surgery(n=3),colostomy after colorectal cancer surgery(n=15),permanent ileostomy after total colectomy for ulcerative colitis(n=2),permanent ileostomy after total colectomy for familial polyposis(n=1),incarcerated parastomal hernia(n=6),recurrent parastomal hernia(n=4)and abdominal wall incisional hernia(n=11).Results Dual Lap hybrid repair was successfully completed.During operation,the average diameter of parastomal hernia hernia ring was(6.8±1.7)(3-15)cm,the average diameter of incisional hernia ring(4.8±1.3)(3-7)cm and the average operative duration(100.7±21.5)(90-140)min.No kidney,ureter and bowel injuries were detected intraoperatively.Eight patients required 3-day adjuvant analgesics for pain relief within 72 h post-operation.The average postoperative hospital stay was(8.1±2.7)(7-13)days.No intestinal obstruction,intestinal leakage,local hematoma or wound infection occurred at Day 7 post-operation and 2 cases of postoperative wound fat liquefaction were treated by dressing change.The average postoperative follow-up period was(11.6±4.2)(12-48)month.No intestinal obstruction,recurrence of stoma hernia,incisional hernia,prolapse of stoma canal,chronic pain or patch infection occurred during postoperative follow-ups.Conclusion The new laparoscopic plus open hybrid repair(Dual Lap)is both safe and effective for complex parastomal hernia in adults.It is worthy of wider clinical applications.

关 键 词：造口旁疝 疝修补术 切口疝 腹腔镜手术 

分 类 号：R656.24[医药卫生—外科学]