“对位对线”补片固定法在腹腔镜造口旁疝Sugarbaker修补术中的应用

A novel mesh fixation of“contraposition and alignment”in laparoscopic Sugarbaker repair for parastomal hernia

目的腹腔镜下Sugarbaker修补手术是造口旁疝的主要手术方式,补片固定是手术的关键技术环节,本研究介绍一种新式补片固定方法,并探讨其在临床上的应用效果。方法回顾性分析2017年6月至2019年6月在中山大学附属第六医院住院的66例造口旁疝患者临床资料,患者均行腹腔镜造口旁疝修补手术(Sugarbaker术式),根据补片固定方式的不同分为试验组(41例,采用“对位对线”补片固定法)和对照组(25例,采用传统疝钉双圈补片固定方法)。比较两组患者相关指标和治疗效果。结果两组患者性别、年龄、体质指数、病程以及造口旁疝分型比较,差异均无统计学意义。试验组补片固定时间短于对照组[(32.6±9.0)min vs(38.7±11.0)min,P<0.05],两组在疝钉固定数量、血清肿、补片感染、术后住院时间指标方面,差异无统计学意义。试验组和对照组的平均随访时间差异无统计学意义[(37.6±14.8)个月vs(38.8±15.2)个月,P=0.687],试验组的造口旁疝复发率低于对照组(2.4%vs 20.0%,P<0.05),而两组术后慢性疼痛发生率差异无统计学意义(24.2%vs 24.0%,P=0.971)。结论在腹腔镜造口旁疝Sugarbaker修补术中应用“对位对线”补片固定法,可以缩短补片固定时间并减少术后复发,值得临床上推广使用。

Objective Laparoscopic Sugarbaker repair is the main operation method of parastomal hernia,and mesh fixation is the key technical link.This study develops a novel mesh fixation method and discusses its clinical application effect.Methods From June 2017 to June 2019,66 cases with parastomal hernia undergoing laparoscopic Sugarbaker repair in the Sixth Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively.The patients were divided into trial group and control group according to different methods of mesh fixation,with 41 cases in the trial group by“contraposition and alignment”mesh fixation,and 25 cases in the control group by traditional double loop hernia nail fixation.The clinical data and outcome of the two groups were compared.Results There were no significant differences in gender,age,body mass index,course of disease and classification of parastomal hernia between the two groups.The mesh fixation time in the trial group was shorter than that in the control group[(32.6±9.0)min vs(38.7±11.0)min,P<0.05].There were no significant differences between the two groups in terms of the number of hernia nail,seroma,mesh infection,and postoperative hospital stay.Cases were followed up for(37.6±14.8)months in the trial group,for(38.8±15.2)months in the control group,with no significant difference(P=0.687).The recurrence rate of parastomal hernia in the trial group was 2.4%,which was lower than 20.0%in the control group(P<0.05).There was no significant difference in the incidence of postoperative chronic pain between the two groups(24.2%vs 24.0%,P=0.971).Conclusions The“contraposition and alignment”mesh fixation represents a valid method to shorten the time of mesh fixation and reduce the recurrence of parastomal hernia in laparoscopic Sugarbaker repair.It can be popularized in clinical treatment for parastomal hernia.