Miles术后造口旁疝发生的原因分析及处理

Etiology analysis and management of parastomal hernia after Miles operation

目的分析Miles术后造口旁疝发生的原因及处理方法。方法回顾性分析2007年1月至2013年5月,郑州大学附属肿瘤医院行Miles术158例患者资料,其中经腹直肌旁造口46例,经腹直肌造口83例,经腹膜外造口29例;16例术后出现造口旁疝,其中经腹直肌旁11例,经腹直肌5例;对造口旁疝发生的原因进行分析总结。结果 10例经无张力疝修补手术后痊愈,6例经保守治疗后痊愈,未出现复发病例;1例发生切口感染,经换药和充分引流、抗感染后痊愈;1例慢性疼痛,给予对症治疗;未出现严重的补片相关并发症。结论本组患者造口旁疝的发生与造口方式、手术操作、腹压增加有关,根据病情采用保守或手术治疗。

Objective To analyze the reasons and treatment of parastomal herriia after Miles operation. Methods The clinical data of 158 patients who underwent abdominal perineal resection of low reetal cancer in Affiliated Tumor Hospital of Zbengzhou University, from January 2007 to May 2013, were retrospectively reviewed. Of these, 46 patients had lateral rectus abdominis positioned stoma, 83 had trans- reetus stoma, and 29 were extraperitoneal stoma. A total of 16 patients had developed the parastomal hernia after operation, including 11 eases in lateral reetus patients, and 5 cases in trans-rectus patients. The possible reasons of parastomal hernia were summarized. Results 10 eases of parastomal hernia had cured by tension-free hernia repair, and 6 had cured by conservative treatment. Wound infection occurred in only 1 patient, who cured by dressing, drainage and antibiotic treatment. Chronic pain was observed in 1 patient and had been treated by symptomatic treatment. None of serious mesh-related eomplications was found. Conclusion The reasons of parastomal hernia in this series was associated with the way of eolostomy, surgical operation, and increased abdominal pressure. Either conservative or operative treatment ean be taken according to the state of illness.