腹壁巨大切口疝一期并肠造口还纳修补治疗体会

Treatment experience of single-staged repair of large ventral incisional hernia with the ileo/colostomy closure

目的总结腹壁巨大切口疝一期并肠造口还纳修补的治疗体会,探讨存在污染风险切口一期疝修补的可行性。方法腹壁巨大切口疝并肠道单腔造口患者7例,均行一期肠造口还纳和切口疝无张力修补术,其中置入补片4例。结果术后均3~5天排气,原造口处切口感染2例,排便不规律6例,术后半年出现不全性肠梗阻1例,原造口处皮肤凹陷5例,均无肠瘘、腹腔间隔室综合征等并发症。平均住院时间(22±5)天,现随访1年,均诉满意。结论肠造口还纳并腹壁巨大切口疝一期手术安全可行,有一定污染风险的切口并不是一期疝修补以及补片应用的绝对禁忌证。

Objective To summarize the experience of the single-staged repair of large ventral incisional hernia with the ileo/colostomy closure,and discuss the feasibility of single-staged surgical treatment of abdominal wall hernias with possible contaminated fields. Methods A retrospective analysis of 7cases of abdominal giant incisional hernia and ileo/colostomy patients,the single-staged surgical treatment of incisional hernia repair and stoma closure was performed,placed the patch in 4 cases. Results Postoperatively,of all patients the intestinal transit resumed on day 3 - 5,2 cases of superficial wound infections at primary colostomy incision,6 cases of irregular bowel movements,only one occurred an incomplete ileus after half a year,5 cases of abdominal wall sinus,neither of all occurred intestinal fistula nor abdominal interval syndrome. At the 1-year follow-up,the patients did not show any suggestive signs or symptoms of complications or recurrence. Conclusion The single-staged repair of large ventral incisional hernia with the ileo/colostomy closure is safe and feasible,certain pollution risk is not a absolute contraindication for incisional hernia repair and even with the mesh imbedded.