基于疝外科理念的肠造口还纳策略  

Strategies for stoma reversal based on hernia surgery principles

作　　者：陈璐[1,2,3] 黄耿文[1,2,3] CHEN Lu;HUANG Gengwen(Hernia and Abdominal Wall Surgery Center,Xiangya Hospital,Central South University,Changsha 410008,China;Department of General Surgery,Xiangya Hospital,Central South University,Changsha 410008,China;National Clinical Medical Research Center for Geriatric Diseases,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院疝和腹壁外科中心,湖南长沙410008 [2]中南大学湘雅医院普通外科,湖南长沙410008 [3]中南大学湘雅医院国家老年疾病临床医学研究中心,湖南长沙410008

出　　处：《中国普通外科杂志》2024年第10期1594-1599,共6页China Journal of General Surgery

摘　　要：肠造口还纳术通常在临时性肠造口术后3~6个月施行,用于恢复肠道的连续性。肠造口还纳术后切口疝(SSIH)的高发生率问题不容忽视,SSIH一旦形成,不仅增加患者的心理负担和经济负担,也明显增加医疗风险和社会负担。因此,降低SSIH的发生率,具有十分现实的意义,最根本的策略是根据已知的危险因素包括:女性、年龄≥68岁、结肠造口、BMI≥25 kg/m2、恶性肿瘤、急诊手术、已形成造口旁疝、合并中线切口疝和术后伤口并发症等准确识别高危患者,提前进行预防。由于造口肠管造成的腹壁缺损类似于切口疝时肠管疝出的状态,对于腹壁切口疝形成的高危患者,在进行肠造口还纳术时,按照切口疝的修补理念,在关闭腹部切口时预防性置入补片,进行腹壁的闭合和加强,将有助于预防切口疝的发生,且不会增加手术部位感染及手术部位不良事件。但对于肠造口还纳术中应该使用何种材质的补片仍然存在争议。总之,造口还纳术与普通腹部切口不同,用疝外科理念来关闭此类切口,将成为预防SSIH形成的关键措施。ce of stoma site incisional hernia(SSIH)after stoma closure is a significant concern,as the development of SSIH not only increases psychological and financial burdens on patients but also significantly raises medical risks and societal costs.Therefore,reducing the incidence of SSIH is of great practical importance.The fundamental strategy is to accurately identify high-risk patients based on known risk factors,which include:female sex,age≥68 years,colostomy,BMI≥25 kg/m2,malignancy,emergency surgery,existing parastomal hernia,concurrent midline incisional hernia,and postoperative wound complications,and to implement preventive measures in advance.Given that the abdominal wall defect caused by the stoma resembles the condition of bowel herniation in incisional hernias,applying the principles of incisional hernia repair during stoma reversal surgery-particularly for high-risk patients-can be beneficial.This involves the prophylactic use of a mesh during abdominal closure to reinforce the abdominal wall,which may help prevent the occurrence of incisional hernia without increasing the risk of surgical site infections or other adverse events.However,there is still debate over the optimal type of mesh to use during stoma reversal.In summary,stoma reversal incisions differ from standard abdominal incisions,and employing hernia repair principles for their closure may be a crucial strategy in preventing the development of SSIH.

关 键 词：肠造口术 切口疝 外科网 

分 类 号：R656.7[医药卫生—外科学]