复发性结肠造口旁疝再修补安全性与术式选择研究

Safety and surgical selections for reoperation of recurrent paracolostomy hernia

目的 探讨复发性结肠造口旁疝再修补的安全性及治疗策略。方法 回顾性分析2011年2月至2021年7月复旦大学附属华山医院普外科收治的行修补手术治疗的40例复发性结肠造口旁疝病人的临床资料。分别采用开放缝合修补或腹腔镜探查及手术(包括Lap-re-do缝合修补、Lap-re-do Keyhole修补、Lap-re-do Sugarbaker修补、全腹腔镜Sugarbaker修补),随访观察治疗效果。结果 40例病人中13例行开放缝合修补,3例行Lap-re-do缝合修补,7例行Lap-re-do Keyhole修补,14例行Lap-re-do Sugarbaker修补,3例行全腹腔镜Sugarbaker修补。术后30 d内再次入院2例,均为肠梗阻;术后30 d内再手术1例,原因为引流管断裂。术后共12例病人再次复发;10例病人发生肠梗阻;5例发生局部感染,其中2例补片感染;3例病人发生造口出血;2例病人发生造口塌陷。结论 复发性造口旁疝再次修补安全可行,需选择个体化的治疗方式。具体策略为:(1)对急诊梗阻病人首选开放缝合修补,以解除梗阻优先。(2)对既往使用聚丙烯补片修补的病人可采取直接开放缝合。(3)对腹腔情况不明者优先采取腹腔镜探查,根据具体情况合理选择适当的修补术式。

ObjectiveTo investigate the safety and surgical selections of the reoperation of recurrent paracolostomyhernia.MethodsClinical data of 40 patients with recurrent paracolostomy hernia admitted to Huashan Hospital,FudanUniversity from February 2011 to July 2021 were studied. The patients were treated with open tissue suture repair and alaparoscopic exploration strategy. Laparoscopic exploration was subdivided into Lap-re-do suture repair,Lap-re-doKeyhole repair,Lap-re-do Sugarbaker repair,and totally endoscopic Sugarbaker repair. The patients were followed up toobserve the clinical outcomes.ResultsAmong the 40 patients,there were 13 open suture repairs,3 Lap-re-do suturerepairs,7 Lap-re-do Keyhole repairs,14 Lap-re-do Sugarbaker repairs,and 3 totally laparoscopic Sugarbaker repairs.Within 30 days after operation,2 cases were re-admitted to the hospital because of intestinal obstruction;1 case was re-operated because the drainage tube was broken and part of it was left in the abdomen. A total of 12 patients sufferedrecurrence after the operation,10 patients had intestinal obstruction,5 had a local infection,2 with patch infection,3 hadstoma hemorrhage,and 2 had stoma collapse.ConclusionReoperation of recurrent parastomal hernia is safe andfeasible,and individual treatment should be selected. The strategies are:(1) Open suture repair is the first choice foremergency obstruction patients,and the priority is to solve the obstruction.(2) Direct open suture repairs can be used forpatients with a history of using polypropylene meshes.(3) Laparoscopic exploration can be used in unknown abdominalsituations to choose the appropriate surgical techniques according to the specific circumstances.