模式化裁剪补片塑形修补治疗腹会阴联合直肠癌切除术后会阴疝经验总结

Summary of experience with patterning cropped and shaped mesh repair for perineal hernia after abdominoperineal excision in rectal cancer

目的探讨模式化裁剪补片对腹会阴联合直肠癌切除术后会阴疝患者的塑形修补效果。方法回顾性分析2017年3月至2022年12月就诊于福建医科大学附属第一医院肝胆胰、疝外科的8例腹会阴联合直肠癌切除术后会阴疝患者的临床资料。男性3例,女性5例,年龄(67.6±7.2)岁(范围:56~76岁),直肠癌术后第(11.3±2.9)个月(范围:5~13个月)出现会阴部肿物。手术缺损修补采用15 cm×20 cm防粘连补片,经模式化裁剪、塑形为近网兜状以适应盆腔缺损,并于补片前方裁剪出两侧细长固定带固定于前方耻骨梳韧带。结果8例患者手术均顺利完成,手术时间(240.6±48.8)min(范围:155~300 min)。5例患者行开腹手术,3例患者先尝试行腹腔镜手术,后中转开腹联合会阴部入路。3例患者术中发生肠管损伤。所有患者术后无肠瘘、出血,无再手术,术前症状均得到明显改善。术后住院时间(13.5±2.9)d(范围:7~17 d),2例患者术后发生肠梗阻,经保守治疗后好转。2例患者术后会阴部疝囊内积液,其中1例因合并感染行疝囊积液穿刺置管,并持续冲洗引流后治愈。术后随访(34.8±14.0)个月(范围:13~48个月),1例患者于术后第7个月会阴疝复发,未再行手术治疗。结论腹会阴直肠癌切除术后会阴疝手术优先选择经腹部入路,必要时行腹会阴部联合入路,模式化裁剪补片塑形修补方案的治疗效果较好,可用于腹会阴联合直肠癌切除术后会阴疝的治疗。

Objective To examine the patterning cropped and shaped mesh repair for perineal hernia after abdominoperineal excision(APE)in rectal cancer.Methods The clinical data of 8 patients with perineal hernia after APE who accepted surgical treatment in the Department of Hepatopancreatobiliary and Hernia Surgery,the First Affiliated Hospital of Fujian Medical University from March 2017 to December 2022 were retrospectively reviewed.There were 3 males and 5 females,aged(67.6±7.2)years(range:56 to 76 years).Eight patients developed a perineal mass at(11.3±2.9)months(range:5 to 13 months)after APE.After surgical separation of adhesion and exposing the pelvic floor defect,a 15 cm×20 cm anti-adhesion mesh was fashioned as a three-dimensional pocket shape to fit the pelvic defect,then fixed to the promontory or sacrum and sutured to the pelvic sidewalls and the anterior peritoneum,while two side slender slings were tailored in front of the mesh and fixed on the pectineal ligament.Results The repair of their perineal hernias went well,with an operating time of(240.6±48.8)minutes(range:155 to 300 minutes).Five patients underwent laparotomy,3 patients tried laparoscopic surgery first and then transferred to laparotomy combined with the perineal approach.Intraoperative bowel injury was observed in 3 patients.All patients did not have an intestinal fistula,bleeding occurred.No reoperation was performed and their preoperative symptoms improved significantly.The postoperative hospital stay was(13.5±2.9)days(range:7 to 17 days)and two patients had postoperative ileus,which improved after conservative treatment.Two patients had a postoperative perineal hernia sac effusion,one of them underwent placement of a tube to puncture the hernia sac effusion due to infection,and continued irrigation and drainage.The postoperative follow-up was(34.8±14.0)months(range:13 to 48 months),and 1 patient developed recurrence in the seventh postoperative month,no further surgery was performed.Conclusions Surgical repair of the perineal hernia after APE can be preferred transabdominal approach,routine application of laparoscopy is not recommended,combined abdominoperineal approach can be considered if necessary.The perineal hernia after APE can be repaired safely and effectively using the described technique of patterning cropped and shaped mesh repair.