机器人与腹腔镜手术治疗造口旁疝18例临床分析

Clinical analysis of 18 cases with parastomal hernia treated by robotic and laparoscopic surgery

目的探讨达芬奇机器人和腹腔镜微创手术在造口旁疝治疗中的应用。方法回顾性分析2018年4月至2022年4月在福建医科大学附属协和医院使用达芬奇机器人系统和腹腔镜行微创造口旁疝无张力修补术的18例患者资料。记录并比较两组手术时间、术中出血量、恢复进食时间、术后切口感染、麻痹性肠梗阻、引流管拔除时间、住院天数等,远期随访指标包括复发、补片感染、慢性疼痛。结果18例均顺利完成造口旁疝无张力修补术,合并行造口重建术4例(22.2%)。Sugarbaker法修补13例(72.2%),其中使用达芬奇机器人系统2例,使用腹腔镜11例;Keyhole法修补5例(27.7%),其中使用达芬奇机器人系统1例,使用腹腔镜4例。手术时间191~406 min,平均(276.8±71.3)min。术中出血量20~100 ml,平均(29.3±22.2)ml。术后第2天恢复流质饮食,第3天进食半流质;放置引流管病例,术后5~7 d拔除引流管;常规腹带束缚3~6个月。术后住院时间3~19 d,平均(8.2±4.7)d。术后复发1例(5.6%),切口感染1例(5.6%),麻痹性肠梗阻3例(16.7%),肺部感染6例(33.3%),切口感染及麻痹性肠梗阻病例均经过非手术治疗后痊愈出院。随访期间均未出现复发、补片感染、慢性疼痛。结论使用达芬奇机器人系统和腹腔镜进行微创造口旁疝无张力修补术均安全可行,围手术期并发症少,术后恢复快,疗效确切。

Objective To explore the application of robotic and laparoscopic minimally invasive surgery in parastomal hernia repair.Methods The data of 18 patients who underwent parastomal hernia tension-free repair using robotic and laparoscopic minimally invasive surgery from April 2018 to April 2022 in Fujian Medical University Union Hospital were retrospectively analyzed.The operation time,intraoperative bleeding,recovery time of eating,postoperative incision infection,paralytic intestinal obstruction,drainage tube extraction time,hospital stay,and long-term follow-up indicators including recurrence,patch infection,and chronic pain were recorded and compared between the two groups.Results Tension-free repair of parastomal hernia was successfully completed in 18 cases,and 4 cases(22.2%)underwent stoma reconstruction.Sugarbaker method was performed in 13 cases(72.2%),of which 2 cases used robotic surgery and 11 cases used laparoscopic surgery.Keyhole method was performed in 5 cases(27.7%),of which 1 case used robotic surgery and 4 cases used laparoscopic surgery.The mean operative time was 191-406 min,with an average of(276.8±71.3)minutes.Intraoperative blood loss was 20-100 ml,with an average of(29.3±22.2)ml.Liquid diet was resumed on the second day after operation,and semi-liquid diet was taken on the third day.The drainage tube was placed and removed 5-7 days after the operation.The routine abdominal girdle was restrained for 3-6 months.The postoperative hospital stay was 3-19 days,with an average of(8.2±4.7)days.Postoperative recurrence occurred in 1 case(5.6%),incision infection in 1 case(5.6%),paralytic intestinal obstruction in 3 cases(16.7%),pulmonary infection in 6 cases(33.3%),and incision infection and paralytic intestinal obstruction were cured and discharged after non-surgical treatment.There was no recurrence,patch infection or chronic pain during the follow-up period.Conclusion The tension-free repair of parastomal hernia using robotic system and laparoscopic surgery is safe and feasible,with few perioperative complications,fast postoperative recovery,and definite curative effects.