腹腔内放置复合补片原位修补巨大造口旁疝八例

Use of composite patch in an in situ intra-abdominal huge parastomal hernia repair in eight cases

目的总结应用复合补片腹腔内修补巨大造口旁疝的经验。方法回顾性分析复合补片经腹腔内修补巨大造口旁疝8例的临床资料,其中男性6例,女性2例,年龄46～63岁,平均54.7岁。患者均因直肠癌行Miles手术后发生造口旁疝,疝病史3～8年,其中复发性造口旁疝2例。疝环最大径11～15 cm,平均12.6 cm。根据疝环大小选择合适补片,补片边缘均超出疝环缘3 cm以上。在补片中心剪-3 cm直径的孔,并在孔的一侧剪开补片,将补片中心孔套入造口肠管,补片其他部分覆盖住腹壁缺损,补片聚四氟乙烯面朝向腹腔,聚丙烯面朝向腹壁。用2-0的Prolene线连续缝合补片被剪开的一侧裂口,并将补片中心孔的聚四氟乙烯材料缘与造口肠管用3-0的可吸收线间断缝合固定4～5针。然后用1-0的Prolene线经全腹壁穿刺缝合方式,将补片铺平并固定于腹壁,间隔距离5 mm。多余皮肤行适当整形。结果手术时间97～146min,平均109 min。伤口均一期愈合,1例发生浆液肿,2例发生术后近期修补区刺痛。随访3～27个月,平均20个月,无复发。结论复合补片经腹腔内修补巨大造口旁疝是一种安全有效的方法。

Objective To evaluate an in situ parastomal hernia repair using composite patch. Methods Eight patients of age 46 - 63 years （average 54.7 years） with intractable huge parastomal hernia underwent an intra-abdominal onlay implantation repair using composite mesh. There were 2 females and 6 males. The patients had had a history of Miles procedure for their rectal cancer and suffered from parastomal hernia for from 3 to 8 years and a previous failure of repair in 2 cases. The maximal diameter of the hernia ring was 11 cm to 15 cm. The patch was trimed with a 3 cm rim exceeding the hernia border. At the center of the prosthetic mesh a round hole was cut to containe the stoma. The mesh was placed with the E-PTFE side facing ventrally and fixed with stiches. Results The operation time was 97 - 146 minites, wounds were healed by first intention in all cases except for one in which serosity tumefaction occurred. Two patients suffered from transient sting near the operation area shortly after the operation. During a follow-up ranging 3 - 27 months no recurrence was found. Conclusion The introabdominal repair technique for a huge parastomal hernia using a composite prosthetic patch is a feasible and safe method.