造口旁疝的诊治现状及展望

造口旁疝是永久性肠造口术后最常见的并发症之一,是临近或位于造口旁的腹壁切口疝的一种。其发病率很高,且随着肠造口术的时间延长而增加。大部分造口旁疝患者是无症状的,经保守治疗效果显著,但一些患者因出现难以忍受的腹痛、造口装置的侧漏、造口周围皮肤的刺激及腹部膨隆引起的美容问题等需要接受手术治疗。手术修补方式主要包括3种：传统缝合修补术、造口移位术及补片修补术。对于有高危险因素的患者,预置补片成为具有较高经济效益的选择。在此就该病的相关危险因素、诊断及治疗方面的国内外研究进展进行总结论述。     

补片修补造口旁疝38例疗效

目的总结造口旁疝应用Keyhole补片及超普平片进行疝修补术的疗效。 方法回顾性分析2005年1月至2018年4月,上海交通大学附属第六人民医院采用Keyhole补片及超普平片对38例造口旁疝患者行疝修补术治疗的临床资料。 结果38例造口旁疝患者均采用置入补片的疝修补术实施修补。其中15例行开放手术,6例行纯腔镜下腹膜内补片植入手术,5例行开放结合腔镜的杂交手术,12例行Lap-re-Do手术。手术时间40～300 min,平均（150±72）min。全部随访时间2～46个月,其中造口旁疝复发2例（缝合疝环、补片加固）,浆液肿4例,切口感染3例,造口肠管血运轻度障碍1例,均处理痊愈。 结论造口旁疝应积极应用补片行疝修补手术,疗效可靠。术式需根据术前仔细评估和术中情况做相应选择。     

应用聚丙烯补片腹膜前修补造口旁疝16例

目的 探讨聚丙烯补片腹膜前修补术在直肠癌术后并发造口旁疝中的临床应用.方法 回顾性分析2006年6月至2012年5月涿州市医院应用聚丙烯补片腹膜前修补手术治疗直肠癌术后造口旁疝16例患者的临床资料、手术方法及治疗效果.结果 所有患者术后切口均一期愈合,术后随访6个月至5年,除2例患者有腹壁修补处僵硬不适感外,其他患者无腹胀、腹痛、排便不畅等症状,无切口感染、脂肪液化、补片取出者,无造口狭窄或缺血坏死等情况.结论 应用聚丙烯补片腹膜前修补术治疗直肠癌术后并发造口旁疝是一种安全、有效、可靠、符合生理的治疗方法,值得推广应用.     

不同手术方式治疗腹壁造口旁疝24例

目的 探讨造口旁疝的病因、修补方法及临床疗效.方法 回顾性分析2006年7月至2010年7月安徽医科大学第二附属医院收治的腹壁造口旁疝64例,手术治疗24例,比较三种手术方式的术后复发率及并发症情况.结果 行Onlay修补术5例,复发1例,复发率20%.行Sublay修补术12例,复发2例,复发率16.66%;出现皮下积液、切口感染3例.行IPOM修补术7例,复发1例,复发率14.28%;出现肠粘连肠梗阻症状1例,出现肠漏1例.三组手术方式相比,IPOM及Sublay修补术造口复发率稍低,但无统计学意义（χ2=0.462,P=1.000）.预防性使用补片病例无一例发生造口旁疝,造口旁疝发生率低于常规手术组（χ2=1.533,P=0.539）.结论 造口旁疝发病率较高,修补术后复发率高,并发症多,至今仍无统一的修补标准.预防性放置补片可有效的降低造口旁疝发生率.     

腹腔镜造口旁疝修补术常见并发症及其处理方法

<正>造口旁疝是腹部各类造口手术后常见的晚期并发症之一,回肠造口旁疝发病率约28%,结肠造口旁疝发病率高达48%[1]。近年,由于腹腔镜切口疝补片修补手术的成功,腹腔镜技术开始用于治疗造     

生物补片在合并造口旁疝的肠造口还纳术中的应用

目的探讨生物补片在合并造口旁疝的肠造口还纳术中的应用价值。 方法回顾分析2017年5月10日至2019年9月30日中山大学附属第六医院,应用生物补片（SIS）在合并造口旁疝的肠造口还纳术中进行一期修补的22例患者的临床资料,观察造口部位切口疝（SSIH）的发生率及术后疼痛、血清肿、补片感染等并发症发生率。 结果所有手术均顺利完成,Onlay修补16例,Sublay修补6例。仅1例（4.5%）出现SSIH（Onlay修补）,术后疼痛以轻-中度为主,1周内基本回复正常,无血清肿、补片感染病例。Onlay与Sublay修补在SSIH发生率和其他并发症发生率方面差异无统计学意义。 结论应用生物补片在合并造口旁疝的肠造口还纳手术中加强筋膜缺损,在不明显增加手术并发症的情况下能显著降低SSIH的发生率,是一安全、有效的方法。     

腹腔镜造口旁疝补片修补术的应用

造口旁疝是各种腹部造口手术后常见的后期并发症之一,术后两年内其发生率高达48%[1],多数造口旁疝患者会出现皮肤刺激感、局部钝痛等症状,同时由于疝囊及其内容物不断增大,不仅会影响造口装置的密封性,而且常出现阵发性腹痛等不全性肠梗阻症状,甚至发生完全肠梗阻、肠坏死等严重并发症,这些均大大降低了患者术后的生活质量,甚至威胁患者的生命安全.造口旁疝的治疗一直较为棘手,由于常用的造口缺损区域直接缝合修补术有较高的复发率,造口移位加缺损区域缝合修补,不仅有较高的切口疝发生率,而且可能发生新的造口旁疝,另外对患者的心理及护理均有不利影响,而剖腹补片修补术虽可降低一定的复发率,却有因污染而致手术失败的可能.因此,对于造口旁疝,多主张保守治疗[2],除非有疝嵌顿而必须急诊手术.     

腹腔镜造口旁疝修补术13例报告

目的探讨采用腹腔镜钥匙孔手术行造口旁疝修补术的可行性。方法回顾性分析2007年11月～2011年10月采用钥匙孔技术及Proceed补片完成的13例腹腔镜造口旁疝修补术的临床资料。2例回肠代膀胱造瘘,11例左下腹永久性乙状结肠造瘘,其中1例为造口旁疝修补术后复发。术中游离疝周粘连后,将补片适当修剪,中间留圆孔,置于疝囊下方,用5mm螺旋钉枪固定于腹壁。结果所有患者均顺利完成手术。术中并发症2例：横结肠系膜血管损伤1例,造瘘肠管损伤1例;术后并发症3例：切口感染1例,血清肿2例。术后随访5-52个月,平均26个月,1例复发,1例死于肺部感染。结论采用腹腔镜钥匙孔手术及Proceed补片行腹腔镜造口旁疝修补术是安全可行的,临床疗效较为满意,在降低造口旁疝修补术后补片相关并发症发生率和复发率方面具有一定的意义。     

腹壁疝修补材料学研究进展

<正>目前,临床应用补片材料各种各样,每种材料都有其独特的理化特性及生物学特性。对于疝外科医师,熟悉这些常用的补片材料有助于补片的合理选择及对病人进行个体化治疗,并可对病人的术后并发症及复发情况做一粗略估计。本文对疝修补材料研究进展进行综述。1补片在腹壁疝修补中应用现状一项关于造口旁疝的研究显示,传统的无补片造口旁疝修补术切口感染发生率为9.4%,其他并发症发生率为14.1%,疝复发率为57.6%(48.4%~66.0%);在使用补片修     

腹腔镜下行造口旁疝补片修补术

目的:探讨腹腔镜下应用补片行造口旁疝修补术的方法、安全性及临床效果.方法:2004年11月～2006年8月,对10例造口旁疝进行腹腔镜下补片修补术.结果:10例均在腹腔镜下行腹腔内粘连松解和补片固定,顺利完成造口旁疝修补手术.手术时间65～135 min,平均92 min.术后住院6～9 d,平均7 d.术后持续疼痛达3个月以上者3例,术后浆液肿2例,经穿刺抽液和加压包扎后治愈.无手术死亡、无造口感染和肠瘘发生.随访7～26个月(平均13个月),未见造口旁疝复发.结论:腹腔镜下行腹腔内粘连松解、采用腔内缝合器固定补片来修补造口旁疝是一种安全、有效的微创方法,值得推广应用.     

Recurrent parastomal hernia and middle incisional hernia: surgical treatment through midline incision with wide prosthetic mesh

Parastomal hernia is a frequent complication of stoma surgery. The results of parastomal hernia repair however are poor, showing an high incidence of postoperative recurrences. In the last years, hernia repair with prosthetic mesh has given better postoperative results. The parastomal hernia, however, is associated with middle incisional hernia. The authors review the problem of surgical repair of parastomal hernia and report a case of recurrent parastomal hernia associated to middle incisional hernia. The technique of surgical repair using, through midline incision, one, wide, prosthetic polypropylene mesh, in sublay position, according to Rives' technique, is described. The mesh has been incised in a trasverse direction for the stoma crossing. At 6 years follow-up the patient does not show postoperative recurrence. According literature and the authors' results, the parastomal hernia might be considered an incisional hernia and, therefore, a sing of diffuse abdominal wall disease. The Rives' surgical technique might be the gold standard for treatment of parastomal hernia, even if not associated to incisional hernia. The more complexity of Rives' technique compared to local fascial mesh repair is compensated by the result of total abdominal wall reinforcement.     

Preventing and Treating Parastomal Hernia

Parastomal hernia represents a major surgical challenge. There is no uniform definition of parastomal hernia, and the true rate is therefore difficult to establish, although it is probably higher than 30%. Many surgical techniques have been tried to prevent and treat parastomal hernia; but despite these efforts, herniation continues to be a problem. The only method that has reduced the rate of parastomal hernia in a randomized trial is the use of a prophylactic prosthetic mesh. A large-pore low-weight mesh with reduced polypropylene content and a high proportion of absorbable material placed in a sublay position at the primary operation significantly reduces the rate of parastomal hernia. Recurrence rates after surgical treatment of parastomal hernia are high unless mesh is used. Relocation of the stoma, with prophylactic mesh in a sublay position at the new site and sublay mesh repairing the incisional hernia at the primary site, is the standard method for treating parastomal hernia in our department.     

Parastomal hernia repair and prevention with PHSL type mesh after abdomino-perineal rectum extirpation

The parastomal hernia is a continuing challenge, because of the disappointing results of the different procedures available to repair it. The mesh implantation seems to be the best, but not optimal method with 8-22 % recurrence rate and about 15-20% other complications. The PHSL (Polypropylene hernia system large; Ethicon inc. Johnson and Johnson, USA) device proved to be an acceptable solution in correction the medium and large parastomal hernia with low recurrence and complication rate. The device enforces the abdominal wall with double mesh layer connected with a tube. The sigmoid colostomy is lifted trough the tube to the abdominal surface. The device was implanted with preventive intent in 14 cases, without any parastomal hernia formation in the first postoperative year. The preventive PHSL mesh implantation at the Miles operation seems to be an useful method for prevention of parastomal hernias.     

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造口旁疝是腹部外科领域具有挑战性的疾病。应用传统非手术和手术改进方法预防造口旁疝收效较小,而近年来引入的造口时以Sublay方法预防性放置补片的主张和技术有可能会使造口旁疝的发生率发生显著的变化。传统的原位或移位组织对组织修补方法术后复发率很高,由于修补材料应用,造口旁疝的手术治疗近期效果已获得明显改善,但远期效果还难以确定,需要进一步随访观察,特别是大组的、随机对照的临床试验研究。     

造口旁疝诊断和治疗中值得关注的若干问题

造口旁疝是疝与腹壁外科领域较为棘手的疾病之一,目前我国造口旁疝的流行病学资料仍不完善。通过查询结直肠肿瘤相关流行病学资料及国内几家大型结直肠外科中心的数据,粗略的对我国造口旁疝发生率进行估计分析。虽然我国接受永久性造口的病人数量相对不多,但造口旁疝的发生率很高,可达到>80%。造口旁疝修补手术复杂,影响手术的因素很多,治疗效果并不理想,复发率高,甚至在一段时间后产生严重的并发症。因此,目前仍然建议严格掌握手术指征。同时,应充分发挥腹腔镜技术的优势,在多种术式中Sugarbaker手术效果相对更好。另外,随着补片材料的不断改进,预防性造口旁疝补片修补术将会有很好的临床应用前景。     

Management of parastomal hernias

Stoma formation is a common aspect of general, colorectal, urologic, and oncologic surgical practice. Unfortunately, hernia formation around an ostomy trephine occurs in up to 50% of ostomates. In an era of explosive progress in abdominal wall surgery, parastomal hernia repairs remain plagued with technical challenges, high recurrence rates, and peri-operative morbidity. There is little expert consensus on the ideal operation. Repair type (suture or mesh based), surgical approach (laparoscopic, robotic, hybrid, or open), mesh configuration (cruciate, keyhole, or Sugarbaker), mesh type (permanent synthetic, biologic, or bioabsorbable), mesh location (underlay, sublay, or onlay) vary based on local expertise and patient clinical factors. This article will summarize the current literature on the management of parastomal hernias and provide expert commentary on our preferred practices for parastomal hernia repair.     

腹腔镜下造口旁疝补片修补术应用体会

目的探讨腹腔镜下造口旁疝修补术的临床效果。方法回顾性分析2007年9月至2010年4月期间8例行腹腔镜下造瘘口旁疝补片修补术患者的临床资料,分析手术情况、术后并发症及复发情况。结果 8例造口旁疝患者均在腹腔镜下修补成功。手术时间50～180min,平均135min。疝环大小4.5～6.5cm,平均5.0cm。术后1例出现肠梗阻及复发,后行腹腔镜探查及再次修补术。2例术后早期出现腹胀,1周后腹胀缓解。1例术后出现术区疼痛不适,对症治疗后缓解。本组未发生术区感染。住院时间5～14d,平均7.6d。术后随访1年,除1例复发后行再次手术外,均未见复发。结论腹腔镜下造口旁疝修补术如果注意操作要点,可以替代传统修补术。     

腹壁疝补片修补术后补片感染14例分析

目的：探讨疝修补术后补片感染的原因、预防及治疗方法。方法回顾性分析1997年12月至2013年12月我院收治的14例使用补片修补腹壁疝术后补片感染的临床资料。其中腹股沟疝平片修补1例,腹股沟疝腹膜前间隙修补11例,切口疝1例,使用巴德Composix补片开放式腹腔内补片修补;造口疝1例,腹壁肌肉前置入补片修补。根据感染程度、材料不同采用相应的治疗方法,4例去除补片,10例开放换药。结果全组患者均治愈出院,无围手术期死亡。手术过程中无大出血和膀胱损伤。随访时间8～64个月,1例切口疝术后复发。结论产生补片感染的原因很多,预防感染最为重要。一旦发生补片感染,治疗方法应个体化,有效引流及合理运用抗生素可解决多数聚丙烯（PPM）补片感染,唯膨体聚四氟乙烯（ePTFE）补片需完全去除。     

Lateral repair of parastomal hernia.

INTRODUCTION: Parastomal hernia is a common complication of stoma construction. Although the majority of patients are asymptomatic, about 10% require surgical correction. AIMS: We describe a new surgical approach for the repair of parastomal hernias, which avoids both the need for laparotomy and stoma mobilization. PATIENTS AND METHODS: Nine patients (4 female) with parastomal hernia underwent surgical repair. Median age was 55 years (range 38-73 years). There were 8 para-ileostomy herniae and one paracolostomy hernia. A lateral incision was made approximately 10 cm from the stoma, and carried down to the rectus sheath. The dissection was carried medially towards the stoma, and around the defect in the abdominal musculature. The hernia sac was excised when possible and the fascial defect closed with non-absorbable, monofilament suture. A polyprolene mesh was placed round the stoma by making a slit in the mesh. The skin was closed with subcuticular monofilament absorbable suture. RESULTS: All patients returned to normal diet on the first postoperative day, and were discharged from hospital within 72 h. There were no wound infections, and no recurrences after a median follow up of 6 months (range 3-12 months). DISCUSSION: The technique we describe is simple and avoids the need of laparotomy. The mucocutaneous junction of the stoma is not disturbed, reducing the risk of contamination of the mesh, stenosis or retraction of the stoma. Grooving of the stoma and difficulty in fitting appliances is avoided because the wound is not placed near the mucocutaneous junction. This approach may be superior to other mesh repairs for parastomal hernia.