腹腔镜Sugarbaker七步法修补术在复发性造口旁疝的应用

Application of laparoscopic Sugarbaker seven-step repair technique in recurrent parastomal hernia

目的探讨腹腔镜Sugarbaker七步法修补术在复发性造口旁疝中的应用价值。方法收集2017年1月至2021年5月在中山大学附属第六医院行复发性造口旁疝修补术患者的临床资料和手术录像。评价复发性造口旁疝行腹腔镜Sugarbaker七步法修补的可行性,观察术后复发情况,并结合手术录像复盘分析造口旁疝的复发类型、术中和术后并发症以及术后恢复情况等。结果共纳入11例复发性乙状结肠造口旁疝病例,均为Sugarbaker术后复发。其中男3例(27.27%),女8例(72.73%),年龄69(66~76)岁,体质指数27.11(24.80~27.55)kg/m^(2),病程12(4~24)个月。缺损长轴65.99(57.99~88.71)mm,缺损短轴60.96(49.82~87.00)mm。11例患者均顺利完成腹腔镜Sugarbaker七步法修补术,其中腹腔粘连分离时间30(5.50~35.50)min,缺损关闭时间32(25~46)min,总手术时间201(175~251)min,术中出血量20(10~50)ml。通过手术录像复盘,根据补片是否移位,可将造口旁疝复发类型分为补片移位型(9例,81.82%)和非补片移位型(2例,18.18%)。在补片移位型中,根据补片下缘移位的程度分为部分移位型(6例,66.67%)和完全移位型(3例,33.33%)。术后恢复排气时间2(1~4)d,术后住院时间5(4~7)d,无手术部位感染病例。1例术后出现肺部感染,经对症治疗后好转。中位随访时间34.7(27.53~60.40)个月,无复发病例。结论复发性造口旁疝再次行手术治疗,腹腔镜Sugarbaker七步法修补术是安全可行的。

Objective To investigate the value of laparoscopic Sugarbaker seven step repair technique in recurrent parastomal hernia.Methods The clinical data and surgical videos of patients who underwent recurrent parastomal hernia repair in the Sixth Affiliated Hospital,Sun Yat-sen University from January 2017 to May 2021 were collected.The completion rate of laparoscopic Sugarbaker seven step repair of recurrent parastomal hernia,the postoperative recurrence,and recurrence type of parastomal hernia,as well as intraoperative and postoperative complications and postoperative recovery time were recorded.Results A total of 11 cases of recurrent parasigmoid hernia were included,all of which were recurrent after Sugarbaker operation.Among them,3 cases were male(27.27%),8 cases were female(72.73%),the median age was 69(66-76)years old,the median body mass index was 27.11(24.80-27.55)kg/m^(2),and the median course of disease was 12(4-24)months.The long axis of the defect was 65.99(57.99-88.71)mm,and the short axis of the defect was 60.96(49.82-87.00)mm.All patients successfully completed the laparoscopic Sugarbaker seven step repair,in which the peritoneal adhesion separation time was 30(5.50-35.50)minutes,the defect closure time was 32(25-46)minutes,the total operation time was 201(175-251)minutes,and the intraoperative bleeding volume was 20(10-50)ml.The recurrence types of parastomal hernia were summarized by reviewing the operation video.According to whether the mesh was displaced or not,the recurrence types of parastomal hernia could be divided into mesh displacement type(9 cases,81.82%)and non-mesh displacement type(2 cases,18.18%).According to the degree of displacement of the lower edge of the mesh,the mesh displacement type could be divided into partial displacement type(6 cases,66.67%)and complete displacement type(3 cases,33.33%).The recovery time of exhaust was 2(1-4)days,and the postoperative hospital stay was 5(4-7)days.There were no cases of surgical site infection.One patient developed pulmonary infection after operation and improved after treatment.The median follow-up time was 34.7(25.73-60.40)months,and there was no recurrence.Conclusion Laparoscopic Sugarbaker seven step repair technique is safe and feasible for recurrent parastomal hernia.