造口旁疝修补术式选择及疗效评价(附单中心15年403例报告)

Selection and evaluation of surgical treatment for 403 cases of parastomal hernias in a single-center experience within 15 years

目的 分析造口旁疝不同修补术式的有效性和安全性。方法 回顾性分析2006年1月至2021年1月复旦大学附属华东医院普外科收治的403例造口旁疝病人的临床资料及随访结果,对不同手术方式的临床结局进行分析。结果 所有入组病人均接受手术治疗,年龄(67.1±4.7)岁,BMI为27.5±3.1。手术时间57~620(127.1±30.2)min,术后住院时间为4~61(6.2±2.3)d。术后近期并发症包括手术部位感染(SSI)42例,血清肿或血肿19例,不全性肠梗阻19例,造口并发症7例,肠管损伤2例。另有死亡2例,皆因高龄嵌顿疝急诊手术后出现多器官功能衰竭而死亡。中位随访时间36个月,复发55例(13.6%),造口相关并发症14例,不全性肠梗阻22例,迟发性补片感染7例,慢性疼痛11例。不同术式比较,复发率从高到低依次为:缝合修补(29.4%)、Keyhole手术(15.3%)、Sugarbaker手术(3.2%),Sandwich手术和造口移位无复发;Sugarbaker手术后肠梗阻发生率最高(19.4%)。不同手术入路比较,开放手术后SSI(18.1%)和肠梗阻(6.4%)发生率均为最高,杂交手术病人造口相关并发症发生率最高(7.5%)。结论 治疗造口旁疝的不同手术方法中,Keyhole手术在补片修补手术中复发率最高,Sugarbaker和Sandwich手术复发率相对较低,但须注意预防术后肠梗阻的发生。造口旁疝总体疗效仍有待提高,术式及材料仍需不断发展,腹腔镜修补手术疗效与传统开放手术相近,将占据更重要的治疗地位。

ObjectiveTo analyze the efficacy and safety of different surgical techniques for parastomal hernia.MethodsThe clinical data and follow-up results of 403 patients with parastomal hernia treated in our hospital fromJanuary 2006 to January 2021 were retrospectively analyzed. The clinical outcomes of different surgical methods weresummarized and analyzed.ResultsAll the enrolled patients received surgical treatment,with an average age of(67.1 ±4.7) years. The mean BMI was 27.5 ± 3.1 and the mean operation time was(127 ± 30) min. The average postoperativehospital stay was(6.2 ± 2.3) days. There were 42 cases of SSI,19 cases of seroma or hematoma,19 cases of incompleteintestinal obstruction,7 cases of stomal complications and 2 cases of intestinal injury. Another 2 cases died of multipleorgan failure after emergency operations in elderly incarcerated hernia patients. The median follow-up time was 36months. 55 cases(13.6%)recurred. There were 14 cases of stoma-related complications,22 cases of incompleteintestinal obstruction,7 cases of delayed mesh infection and 11 cases of chronic pain. Compared with different surgicalmethods,the highest recurrence rate of suture repair was 29.4%,followed by keyhole technique(15.3%),sugarbakertechnique(3.2%),sandwich technique and stoma displacement no recurrence;the highest postoperative intestinalobstruction rate was sugarbaker technique(19.4%). Compared with different surgical approaches,the incidence of postoperative SSI(18.1%) and intestinalobstruction(6.4%) was the highest in patientsundergoing open surgery,The incidence of stoma-related complications was the highest in patientsundergoing hybrid surgery(7.5%).Conclusion There are many surgical techniques for parastomal hernia with no significant difference in curative effect between different approaches. The recurrence rate of Keyhole tech.is the highest,and the recurrence rate of Sugarbaker and Sandwich tech. is low,but attention should be paid topreventing postoperative intestinal obstruction. Compared with other hernia diseases, the overall curative effect ofparastomal hernia still needs to be improved, and the operation methods and materials still need to be developed. Thecurative effect of laparoscopic technique is similar to that of traditional ways, and it will lead to the trend.