Onlay法原位修补造口旁疝45例

Onlay mesh in situ hernia repair for parastomal hernia： a report of 42 cases

目的总结采用Onlay法原位修补造口旁疝的方法及疗效。方法2006年2月至2012年4月应用聚丙烯补片经原中线切口入路采用Onlay法原位修补造口旁疝45例。男24例，女21例；年龄43—80岁，平均（49±8）岁。疝病史1—17年，平均（12±3）年。其中复发性造口旁疝6例。疝环直径4～9cm，平均（5．0±2．0）cm。结果45例均顺利完成Onlay手术。手术时问96～148min，平均（109±23）min。术后12h至3d拔除胃管，平均（2．0±2．0）d；术后4—9d拔除引流管，平均（6．0±2．0）d。术后住院时间9～16d，平均（11±3）d。术后42例切口I期愈合；发生浆液肿7例，经穿刺并局部加压后消失。术后41例获随访，随访时间8～48个月，平均（38±8）个月。患者无术区慢性疼痛、腹壁异物感、术区局部膨出等并发症发生。4例分别于术后3、4、4．5个月及7个月复发，经保守治疗及再次手术治愈。结论应用补片经原切口人路采用Onlay法原位修补造口旁疝是一种简便、安全、有效的方法。

Objective To evaluate hernia repair with Onlay （premuscular positioning of the prosthesis） for the treatment of parastomal hernia. Methods In this study 45 patients with parastomal hernia were treated with a tension-free manner of hernia repair in situ by Onlay using prolene mesh between February 2006 and April 2012. There were 24 males and 21 female cases, including 6 recurrent parastomal hernia cases. The average age was （49 ＋ 8 ） years ranging from 43 to 80. The parastomal defect ranged from 4 cm to 9 cm. Results All operations were successful. There was no hospital death or severe postoperative complications. The mean operating time was （ 109 ± 23 ） min （ 96 - 148 ）, and the average time of pulling out the gastrointestinal decompression tube was （ 2. 0 ± 2. 0 ） day （ 12 h - 3 d ） and the drainage tube was removed after （ 5.0 ± 2. O） days （4 - 9 d）. The mean postoperative hospitalization was （ 11 ＋ 3 ） days （9 - 16 d）. 42 cases achieved primary healing. The serofluid swelling in 7 cases was cured by puncturing and pressing the incision. 41 cases were followed-up from 8 to 48 months, and 4 patients suffered from hernia recurrence respestively after 3 months, 4 months, 4.5 months and 7 months. One recurrent case was healed by conservative therapy and the other three were healed by reoperation. Conclusions Hernia repair in situ with Onlay method for parastomal hernia with prolene mesh was a safe and effective.