腹腔镜Keyhole修补术和Sugarbaker修补术治疗末端结肠造口旁疝的比较研究

Comparative study of laparoscopic Keyhole and Sugarbaker technique in the treatment of terminal paracolostomy hernia

目的比较腹腔镜Keyhole修补术与腹腔镜Sugarbaker修补术治疗结肠造口旁疝的效果。方法回顾性分析2015年1月至2021年12月中国科学技术大学附属第一医院疝及减重代谢外科连续收治的因造口旁疝接受腹腔镜下修补的117例患者资料,男性45例,女性72例,年龄(68.6±8.6)岁(范围:44~84岁)。按修补技术分为Sugarbaker组(89例)和Keyhole组(28例)。采用t检验、Mann-WhitneyU检验、χ^(2)检验或Fisher确切概率法比较两组的手术时间、手术相关并发症发生率、术后复发率等数据。结果全部患者随访时间[M(IQR)]为33(36)个月(范围:12~84个月)。与Sugarbaker组相比,Keyhole组疝环面积更大[35(26)cm^(2)比25(16)cm^(2),Z=1.974,P=0.048],住院时间更长[(22.0±8.0)d比(14.1±6.2)d,t=5.485,P<0.01],术后复发率更高[28.6%(8/28)比6.7%(6/89),χ^(2)=7.675,P=0.006]。两组术后并发症发生率无差异(P>0.05)。结论腹腔镜下使用非立体的防粘连补片修补造口旁疝,Sugarbaker修补术的复发率低于Keyhole修补术,但两组术后并发症发生率无差异。

Objective To compare laparoscopic Keyhole repair with Sugarbaker repair in consecutive patients with parastomal hernia.Methods From January 2015 to December 2021,117 patients with parastomal hernia were treated with Keyhole or Sugarbaker laparoscopy repairs in the Department of Hernia and Bariatrci Surgery,the First Affiliated Hospital of University of Science and Technology of China,and the clinical data were retrospectively analyzed.There were 45 males and 72 females,aged(68.6±8.6)years(range:44 to 84 years).Laparoscopic Sugarbaker repair was performed in 89 cases,and Keyhole repair was performed in 28 cases.The t-test,Mann-Whitney U test,χ^(2)test and Fisher exact test were used to compare the observation indicators between the two groups,such as operation time,incidence of operation-related complications,and postoperative recurrence rate.Results The follow-up period was(M(IQR))33(36)months(range:12 to 84 months).Compared to the Sugarbaker group,the hernia ring area of the Keyhole group was bigger(35(26)cm^(2)vs.25(16)cm^(2),Z=1.974,P=0.048),length of stay was longer((22.0±8.0)d vs.(14.1±6.2)d,t=5.485,P<0.01),and the postoperative rate of recurrence was higher(28.6%(8/28)vs.6.7%(6/89),χ^(2)=7.675,P=0.006).There was no difference in operation time and postoperative complications between the two groups.Conclusions Laparoscopic Sugarbaker repair is superior to Keyhole repair in the recurrence rate of parastomal hernia treated with compsite mesh(not funnel-shaped mesh).There are no differences in operation time and postoperative complications between the two groups.