造口还纳术后切口疝的危险因素分析与预防策略  

Analysis of risk factors and prevention strategy of incisional hernia after stoma reduction surgery

作　　者：林凯 潘勇 赵高平 杨春 Lin Kai;Pan Yong;Zhao Gaoping;Yang Chun(Department of Gastrointestinal Surgery,Sichuan Provincial People's Hospital,School of Medicine,University of Electronic Science and Technology of China,Chengdu 610072,China)

机构地区：[1]四川省医学科学院四川省人民医院(电子科技大学附属医院)胃肠外科,成都610072

出　　处：《中华疝和腹壁外科杂志(电子版)》2024年第6期634-638,共5页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

基　　金：四川省科技厅计划项目(2022YFS0166)。

摘　　要：目的分析造口还纳术后造口部位切口疝(SSIH)的临床特点,以期加强临床医生对SSIH的认识和重视。方法回顾性分析2021年1月至2023年5月,四川省医学科学院四川省人民医院(电子科技大学附属医院)胃肠外科收治的行结直肠手术+预防性肠造口手术的232例患者的临床资料。通过随访及影像学检查确诊SSIH,并统计分析发生SSIH的切口部位相关临床特点。结果在232例患者中共有30例(12.9%)发生SSIH。比较不同结局患者的临床特征,结果显示,SSIH患者合并造口旁疝、术后发生切口感染、造口直径>2.5 cm、还纳时是否离断肌肉、缝合时的技术等与未发生SSIH的患者相比,差异均有统计学意义(P<0.05)。合并造口旁疝、还纳后切口感染、造口直径>2.5 cm、间断缝合、离断肌肉是预防性造口还纳术后发生SSIH的独立危险因素[优势比分别为10.31、15.17、5.348、8.203、4.671;95%可信区间分别为(2.680~45.210)、(4.716~57.180)、(1.751~18.380)、(2.338~37.880)、(1.427~18.910)]。结论避免预防性造口过大,防止造口旁疝的出现,还纳时避免切口感染,还纳造口时减少肌肉的离断,缝合切口时采取连续缝合等措施有助于减少SSIH的发生。Objective To analyze the clinical characteristics of stoma site incisional hernia(SSIH)after stoma reduction surgery,in order to enhance clinicians&apos;knowledge and attention to SSIH.Methods The clinical data of 232 cases of colorectal surgery+prophylactic enterostomy admitted to the Department of Gastrointestinal Surgery of Sichuan Provincial People&apos;s Hospital,School of Medicine(Affiliated Hospital of University of Electronic Science and Technology)were retrospectively analyzed from January 2021 to May 2023.SSIH was confirmed by follow-up and imaging results,and the clinical characteristics related to the incision site of SSIH were analyzed.Results A total of 30(12.9%)of the 232 patients developed SSIH.The comparison of the clinical characteristics of the patients with different outcomes showed that compared with the patients without SSIH,the complicated parastomal hernia,postoperative incisional infections,the diameter of the stoma>2.5 cm,whether the muscle was detached during the reduction,and the technique of suture closure in the patients with SSIH had statistically significant differences(P<0.05).The complicated parastomal hernia,incisional infection after reduction,stoma diameter>2.5 cm,interrupted suture,and detached muscle were independent risk factors for SSIH after prophylactic stoma reduction(Odds Ratio=10.31,15.17,5.348,8.203,4.671;95%confidence interval=2.680-45.210,4.716-57.180,1.751-18.380,2.338-37.880,1.427-18.910).Conclusion Measures such as avoiding excessively large prophylactic ostomy,preventing parastomal hernia,avoiding incisional infection during reduction,reducing muscle detachment during ostomy reduction,and using continuous suture during incision closure can help reduce the incidence of SSIH.

关 键 词：造口还纳术 切口疝 危险因素 预防措施 

分 类 号：R47[医药卫生—护理学]