2017年《欧洲疝学会造口旁疝治疗指南》解读

Interpretation of 2017 European Hernia Society Guidelines for The Prevention and Treatment of Parastomal Hernias

2017年，欧洲疝学会发布了关于造口旁疝预防及治疗的指南，这是国际上第一部关于造口旁疝的治疗指南。该指南围绕造口旁疝的发生率、诊断和治疗，提出了12个问题，并就每个问题进行了深入的讨论。本文对该指南的重点内容作出如下归纳：（1）单筒式结肠造口的造口旁疝发生率较其他造口方式更高。（2）相对于CT或超声检查，体格检查对于造口旁疝的诊断更有必要。（3）建议使用2014年欧洲疝学会推荐的分型方法。（4）明确诊断造口疝后，不建议等待观察。（5）关于造口方式与造口疝发生率的关系，目前尚没有明确有力的数据。（6）建议在择期永久单筒式结肠造口术中，预防性使用不可吸收补片，其他造口方式不推荐预防性使用补片。（7）择期造口疝手术不建议使用缝合修补。（8）关于手术技巧、开放或者腔镜手术以及补片类型的选择方面，尚未有明确有力的数据。但是指南中大部分数据都是回顾性的，证据级别不够，很多问题尚没有定论。期待更多高级别的数据来解答这些问题。

European Hernia Society issued a guideline for the prevention and treatment of parastomal hernias in 2017, which is the first international guideline for the parastomal hernia. This guideline proposed 12 problems about incidence, diagnosis and treatment, and discussed these problems in depth. The main contents of this guideline are summarized as follows： （1） End colostomy is associated with a higher incidence of parastomal hernia compared to other types of stomas. （2） Clinical examination is necessary for the diagnosis of parastomal hernia, whereas computed tomography scan or ultrasonography may be performed in cases of diagnostic uncertainty. （3） The use of the European Hernia Society classification for uniform research reporting is recommended. （4） There is insufficient evidence on the policy in watchful waiting. （5） There is insufficient evidence on the route and location of stoma construction, and the size of the aperture. （6） The use of a prophylactic synthetic non- absorbable mesh upon construction of an end colostomy is strongly recommended. No such recommendation can be made for other types of stomas at present. （7） It is strongly recommended to avoid performing a suture repair for elective parastomal hernia. （8） So far, there is no sufficient comparative evidence on specific techniques, open or laparoscopic surgery and specific mesh types. However, most data in this guideline were retrospective without high level evidence. A lot of questions remain controversial and more high-level evidence are expected to solve these problems.