应用补片Onlay法原位修补造口旁疝48例疗效分析

Evaluation of the in situ Onlay technique in parastomal hernia repair with mesh: a report of 48 cases

目的探讨采用补片Onlay法修补造口旁疝的手术方式及疗效。方法回顾性分析2007年3月至2013年3月,武汉科技大学附属普仁医院采用补片经原手术切口中线Onlay法原位修补48例造口旁疝患者的临床资料。结果 48例患者均完成手术,手术时间100-152 min,平均（122±12）min。手术后12 h至3 d胃管拔出,平均（2.0±0.5）d,术后4-10 d拔出引流管,平均（7.0±2.0）d。手术后住院天数10-18 d,平均住院天数（14.0±2.0）d。46例手术切口为Ⅰ期愈合,2例手术切口为Ⅱ期愈合。48例患者均获得随访,随访时间10-48个月。复发5例,复发率10.4%。1例患者因复发疝较小,复发后立即采用造口腹带固定后痊愈,其余4例患者通过再次手术获得痊愈。8例患者出现浆液肿,通过穿刺及局部加压处理后逐渐好转。结论使用补片经原手术切口中线采用Onlay法原位修补造口旁疝是一种操作简单、有效、安全的方法。

Objective To evaluate Onlay mesh repair for the treatment of parastomal hernia.Methods The clinical data of 48 patients with parastomal hernia who received with Onlay mesh repair in Puren Hospital Affiliated to Wuhan University of Science Technique from March 2007 to March 2013,were analyzed. Results All operations were completed successfully,with mean operating time of（ 122 ±12） minutes（ range 100 to 152 minutes）. Stomach tube were removed in（ 2. 0 ± 0. 5） days,and drainage tube were removed in（ 7. 0 ± 2. 0） days. The average length of hospitalization was（ 14 ± 2） days. The surgical incision successfully healed in 46 cases,and 2 healed by second intention. 48 cases were followed up from 10 to 48 months. 5 recurrence occurred,accounting for 10. 4%. One patient with minor recurrence was healed by conservative therapy and the other four patients were reoperated. 8 patients were presented with seroma,which were improved by puncturing and incision pressing. Conclusion Parastomal hernia repair using in situ onlay technique with mesh was safe and effective.