腹腔镜下切口疝补片修补并乙状结肠造瘘还纳术三例

Laparoscopic incisional hernia repair and simultaneous sigmoid colon stoma closure:Experience of three cases

目的外伤或医源性损伤造成的直肠或乙状结肠穿孔需急诊行乙状结肠造瘘手术,而术后常出现切口感染直至后期的切口疝,探讨如何以最小的创伤同时处理切口疝并还纳造瘘口。方法 2012年1月至2016年7月鞍钢集团总医院收治了3例腹壁切口疝并需还纳乙状结肠造瘘口患者,对其临床资料进行回顾性分析。结果 3例患者均成功完成腹腔镜下操作,无中转,手术时间150~210 min,平均170 min;术中出血量20~70 ml,术后8~10 d后出院,腹壁造瘘处切口及Trocar孔均一期愈合,无吻合口漏、腹腔感染、血清肿等并发症发生。出院后随访6~48个月,无肠漏、再手术取出补片、疝复发等并发症出现。结论对于乙状结肠造瘘口还纳加疝修补是可行的,但需做到科学的选择补片,精细的术中操作,严密的围手术期管理。

Objective Emergency sigmoid colonostomy surgery is usually needed for traumatic or iatrogenic rectum/sigmoid colon perforation, while wound infection and subsequent incisional hernia are common. This article aims to discuss how to simultaneously treat incisional hernia and sigmoid colon stoma with minimal trauma. Methods From January 2012 to July 2016, 3 cases of abdominal incisional hernia complicated with sigmoid colon stoma were treated in General Hospital of Ansteel Group. The clinical data were retrospectively analyzed. Results All 3 patients underwent laparoscopic operation successfully. The operation time was 150-210 min with an average of 170 min. The blood loss was 20-70 ml. The patients were discharged from the hospital in 8 to 10 days after the surgery. Stoma incisions and trocar incisions were healed, without anastomotic leakage, abdominal infection, seroma and other complications. After a follow-up period of 6 to 48 months, no intestinal leakage, mesh removal and hernia recurrence occurred. Conclusion It is feasible to repair hernia with simultaneous sigmoid colon stoma closure. However, it is necessary to make proper mesh selection, careful intraoperative operation and rigorous perioperative management.