造口旁疝修补术的演变和焦点问题

Evolution and focus of parastomal hernia repair

造口旁疝发生率高,且手术修补术后复发率高,是难治疗的腹外疝之一。目前治疗造口旁疝的手术方式多样包括:组织修补术、造口移位术、经疝环的补片修补术、造口移位同期联合补片修补术、Sugarbaker修补术及其改良手术方式、Keyhole修补术及其改良手术方式、Sandwich修补术以及杂交手术方式。但尚无能达到术后复发率低、并发症少满意修复效果的修补手术方式。随经腹膜外腹壁切口疝修补术在腹壁疝的拓宽应用,腹腔镜下腹膜外造口旁疝修补术处于探索阶段;肠造口术中预置补片是否能降低造口旁疝发生率的临床研究存在不同研究结果。笔者认为:造口旁疝的治疗和预防仍是腹壁缺损修复的一项长期艰巨课题,需开展更多高质量、有意义的临床研究进一步探索、加以验证。

Due to the high incidence and postoperative high recurrence rate,parastomal hernia is one of the most difficult ventral hernias for clinical treatment.Currently,there are numerous of surgical options for the treatment of parastomal hernia,including suture repair,stoma relocation,onlay mesh repair through hernia ring,stoma relocation combined with sublay mesh prophylactic and repairing,Sugarbaker technique repair and its modified operation,Keyhole technique repair and its modified operation,Sandwich technique repair and hybrid surgery.However,none of them could achieve a satisfactory efficacy of low recurrence rate and few complications.With the increasing application of enhanced view‑totally extraperitoneal technique in ventral hernia,laparoscopic extraperitoneal parastomal hernia repair has been applied and explored in clinical practice.There are contrary results in clinical studies on whether the prophylatic mesh placement can reduce the incidence of parastomal hernia.Hence,the treatment and prevention of parastomal hernia is still a long‑term and arduous task in the field of abdominal wall defect repair,which needs to be further explored and verified by more high‑quality and meaningful clinical studies.