造口还纳术后切口疝的发生率及危险因素分析

Analysis of incidence and risk factors of incisional hernias after stoma closure

目的探究造口还纳术后原造口部位切口疝的发生率和危险因素。方法回顾性分析2015年7月至2019年12月南京鼓楼医院普外科行造口还纳术患者。记录患者一般资料(性别、年龄、体重指数、合并高血压病、合并糖尿病)、造口手术相关资料(第一次造口为急诊或择期手术、第一次造口是否腔镜手术、良性或恶性疾病造口、回肠或结肠造口、端式或袢式造口、术后造口旁疝)、造口还纳手术相关资料(手术时间、出血量、术后住院时间、术后切口感染、随访时间)、原造口处是否发生切口疝等指标。根据造口还纳术后原造口部位是否发生切口疝分为2组,采用单因素分析及多因素Logistic回归分析评估造口还纳术后发生切口疝的危险因素。结果共纳入89例患者分析,造口还纳术后原造口处切口疝发生率为23.6%(21例),其中9例行二次手术治疗,其他目前行保守治疗。单因素分析及多变量Logistic回归分析提示发生切口疝的独立危险因素包括:结肠造口(OR 7.161,95%CI 1.479~34.667,P=0.014)、年龄≥68岁(OR 1.093,95%CI 1.029~1.161,P=0.004)、急诊手术(OR 6.343,95%CI 1.663~24.190,P=0.007)。造口还纳术后发生切口疝患者体重指数较未发生切口疝患者高[(25.2±3.5)kg/m vs(23.2±2.8)kg/m],差异有统计学意义(P=0.009)。结论造口还纳术后原部位常发生切口疝,往往需要二次手术处理,严重影响患者生活质量,增加其经济负担。结肠造口、年龄≥68岁和急诊手术是造口还纳术后再发切口疝的独立危险因素,对于这部分患者及体重指数≥25 kg/m的患者,造口还纳术联合预防性补片置入术可作为临床治疗方案。

Objective To investigate the incidence and risk factors of incisional hernias after stoma closure.Methods A retrospective analysis was performed on patients undergoing ostomy reduction from July 2015 to December 2019 in the Department of General Surgery of Nanjing Drum Tower Hospital.Gender,age,body mass index(BMI),hypertension,diabetes,benign or malignant disease,ileostomy or colostomy,emergency or elective surgery,stoma(end type or loop type),ostomy was endoscopic or not,operation time,blood loss,postoperative hospital stay,postoperative incision infection,follow-up time,and whether incisional hernia occurred again at the original stoma were recorded.The risk factors for incisional hernia that occurred after stoma reduction were evaluated by univariate analysis and multivariate logistic regression analysis.Results A total of 89 patients were analyzed.The incidence of ostomy site incisional hernias after stoma closure was 23.6%(21 cases),of which 9 underwent surgical treatment and the others received conservative treatment.Univariate analysis and multivariate logistic regression analysis suggested that the independent risk factors for incisional hernia included:colostomy(OR 7.161,95%CI 1.479-34.667,P=0.014),age≥68 years(OR 1.093,95%CI 1.029-1.161,P=0.004),emergency surgery(OR 6.343,95%CI 1.663-24.190,P=0.007).The BMI of patients with incisional hernia after stoma closure was higher than that of patients without incisional hernia[(25.2±3.5)kg/m^(2) vs(23.2±2.8)kg/m^(2)],and the difference was statistically significant(P=0.009).Conclusion Ostomy site incisional hernias after stoma closure often occurs,which often requires secondary surgical treatment,which seriously affects the quality of life of patients and increases the economic burden.Colostomy,age≥68 years and emergency surgery are independent risk factors for incisional hernia.For these patients and patients with BMI≥25 kg/m^(2),stoma closure combined with preventive mesh implantation can be used as clinical treatment.