补片两点标识引导下腹腔镜Sugarbaker造口旁疝修补术单中心120例分析

Laparoscopic Sugarbaker parastomal hernia repair guided by twopoint marking of the mesh:a single-center analysis of 120 cases

背景与目的:造口旁疝是结肠造口术后常见的并发症,发病率高。腹腔镜Sugarbaker修补术是目前治疗造口旁疝的主流术式,但相较于其他腹壁疝修补术,腹腔镜Sugarbaker修补术后的造口旁疝复发率仍居高不下。而且,复发性造口旁疝手术后的复发率远高于初次手术后的复发率,其中侧方位补片不足是重要原因之一。本研究分析采取两点标识引导下腹腔镜Sugarbaker修补术治疗末端结肠造口旁疝患者的疗效,为临床提供循证参考。方法:回顾性收集2015年1月—2023年12月中国科学技术大学附属第一医院疝与肥胖外科120例接受补片两点标识引导下腹腔镜Sugarbaker修补术治疗的末端结肠造口旁疝患者临床数据。根据欧洲疝学会分型对纳入的造口旁疝进行分型,分析补片两点标识引导下腹腔镜Sugarbaker修补术术后患者的症状学复发率和影像学复发率,及复发与未复发患者肠梗阻、造口感染、肠瘘等并发症发生情况。结果:120例患者中,2例(1.7%)失访。平均随访时间为48(6~96)个月。术后症状学复发率为5.1%(6/118),影像学复发率为6.8%(8/118)。复发患者(n=8)与未复发患者(n=110)在性别、年龄、体质量指数(BMI)、疝环缺损面积方面差异无统计学意义(均P>0.05),复发患者手术时间长于未复发患者(P<0.05)。总术后并发症发生率为8.5%(10/118),其中造口皮肤黏膜分离3例,造口感染2例,迟发性肠梗阻2例,早期肠梗阻、疝囊积液、疝囊腔肠管迟发瘘各1例,按Clavien-Dindo分类标准,Ⅱ级6例,Ⅲa级3例,Ⅳ级1例。术后出现并发症与无并发症两组患者在性别、BMI、疝环缺损面积、手术时间和合并症方面差异无统计学意义(P>0.05),术后出现并发症的患者年龄大于无并发症患者(P<0.05)。结论:补片两点标识引导下腹腔镜Sugarbaker修补术的应用降低了造口旁疝的复发率,具有临床推广价值。

Background and Aims:Parastomal hernia is a common complication after colostomy,with a high incidence rate.Laparoscopic Sugarbaker repair is currently the mainstream surgical approach for treating parastomal hernia.However,compared to other abdominal wall hernia repair techniques,the recurrence rate of parastomal hernia after laparoscopic Sugarbaker repair remains relatively high.Furthermore,the recurrence rate after surgery for recurrent parastomal hernias is significantly higher than that after the initial surgery,with inadequate lateral mesh coverage being one of the major contributing factors.This study was performed to analyze the efficacy of two-point mark-guided laparoscopic Sugarbaker repair in patients with terminal colostomy parastomal hernia,so as to provide evidence-based references for clinical practice.Methods:The clinical data of 120 patients with terminal colostomy parastomal hernia,who underwent laparoscopic Sugarbaker repair guided by the two-point mark of mesh at the Department of Hernia and Obesity Surgery,the First Affiliated Hospital of the University of Science and Technology of China,from January 2015 to December 2023,were retrospectively collected.The parastomal hernias were classified according to the European Hernia Society classification.Postoperative symptomatic and radiological recurrence rates were analyzed,as well as the incidence of complications such as bowel obstruction,stoma infection,and intestinal fistula in recurrent and non-recurrent patients.Results:Of the 120 patients,2(1.7%)were lost to follow-up.The mean follow-up duration was 48(6-96)months.The postoperative symptomatic recurrence rate was 5.1%(6/118),and the radiological recurrence rate was 6.8%(8/118).There were no statistically significant differences between recurrent(n=8)and non-recurrent patients(n=110)in terms of sex,age,body mass index(BMI),or hernia defect size(all P>0.05),but the operative time in recurrent patients was longer than that in non-recurrent patients(P<0.05).The overall postoperative complication rate was 8.5%(10/118),including stoma skinmucosa separation(3 cases),stoma infection(2 cases),delayed bowel obstruction(2 cases),early bowel obstruction(1 case),hernia sac effusion(1 case),and delayed fistula formation in the hernia sac cavity(1 case).According to the Clavien-Dindo classification,there were 6 cases of gradeⅡ,3 cases of grade IIIa,and 1 case of gradeⅣcomplications.There were no statistically significant differences between patients with and without complications regarding sex,BMI,hernia defect size,operative time,and comorbidities(all P>0.05);however,patients with complications were older than those without(P<0.05).Conclusion:The application of laparoscopic Sugarbaker repair under the guidance of two-point mesh identification can effectively reduce the recurrence rate of parastomal hernia and It has high clinical applicability.