开放腹横肌松解术治疗造口旁疝合并切口疝20例临床分析

Open transverse abdominal muscle release for parastomal hernia combined with incisional hernia

目的 探讨开放腹横肌松解术治疗造口旁疝合并切口疝的临床疗效。方法 回顾性分析2018年1月至2021年12月浙江大学医学院附属杭州市第一人民医院疝和腹壁外科连续收治的20例造口旁疝合并切口疝病人的临床资料,均行开放腹横肌松解加肌后补片修补术,术后随访观察。结果 20例病人中,男性13例,女性7例。年龄(62.3±10.2)岁。17例(85.0%)为结肠造口,3例(15.0%)为回肠造口。均使用标准型聚丙烯补片,补片大小为(553.9±102.5)cm,手术时间为(146.5±35.8)min,术中出血(137.7±49.3)mL,住院时间为(14.6±3.1)d。术后1例出现浅表手术部位感染,2例Ⅲ型血清肿,均经非手术治疗后治愈。无补片感染、肠梗阻、肠瘘等并发症。随访16.9(5~45)个月,无疝复发或腹壁膨出病例。结论 开放腹横肌松解术是治疗造口旁疝合并切口疝的一种安全、有效的手术方法。

ObjectiveTo investigate the clinical outcomes of open transversus abdominis muscle release in the treat-ment of parastomal hernia combined with incisional hernia.MethodsThe clinical data of 20 patients with parastomalhernia combined with incisional hernia treated by Affiliated Hangzhou First People’s Hospital,Zhejiang UniversitySchool of Medicine from January 2018 to December 2021 were analyzed retrospectively. All patients were treated withopen transverse abdominal muscle release and retro muscular mesh repair.ResultsAmong the 20 patients included inthis study,13 were male and 7 were female. The average age was(62.3±10.2)years old. 17 cases(85.0%)were colostomyand 3 cases(15.0%) were ileostomy. Standard polypropylene meshes were used. The average mesh size was(553.9 ±102.5)cm2,the average operation time was(146.5±35.8)min,the average intraoperative bleeding was(137.7±49.3)m L,and the average hospital stay was(14.6±3.1)d. There was 1 case of superficial SSI and 2 cases of type Ⅲ seroma,whichwere cured after non-surgical treatment. There were no complications such as mesh infection,intestinal obstruction,in-testinal fistula and so on. During the median follow-up time of 16.9(5~45)months,no hernia recurrence or abdominalwall bulge was reported.ConclusionOpen transversus abdominis muscle release is a reliable and effective techniquefor parastomal hernia combined with incisional hernia.