双腔造瘘口旁疝诊疗经验

Experience in treatment of double lumen parastomal hernia

目的探讨双腔造瘘口旁疝诊疗经验。方法收集2020年6月至2024年6月北京朝阳医院疝和腹壁外科行手术治疗双腔造瘘口旁疝的20例患者的临床资料。收集并分析患者性别、年龄、住院时间、入院主诉、入院诊断、手术方式、手术时间、术后并发症在内的基本资料及治疗资料。结果本组患者均顺利完成手术,其中接受腹腔镜联合开腹手术治疗患者17例,完全腹腔镜手术治疗患者2例,完全开放手术治疗患者1例。手术患者中先行造瘘肠管还纳8例:还纳后行IPOM术式修补腹壁缺损3例、开放手术行Sublay修补1例、原位单纯缝合修补后移位行结肠永久性造瘘4例。于术中将双腔造瘘重建为单腔造瘘后再行疝修补患者9例,其中行Sugarbaker术式5例、Keyhole 1例、单纯缝合修补3例。行保留双腔造瘘的腹腔镜造瘘口旁疝修补3例。结论双腔造瘘口旁疝的推荐治疗方案包括造瘘还纳后腹壁修补、更改为单腔造瘘行疝修补、保留双腔造瘘的造瘘口旁疝修补术。手术推荐腹腔镜下放置补片修补腹壁缺损。

Objective To explore the experience in treatment of double lumen parastomal hernia.Methods Collect clinical data of 20 patients who underwent surgical treatment for double lumen parastomal hernia in the Department of Hernia and Abdominal Wall Surgery of Beijing Chaoyang Hospital from June 2020 to June 2024.Collect and analyze basic information and treatment data,including gender,age,length of hospital stay,chief complaint,diagnosis,surgical method,duration of surgery,and postoperative complications.Results All patients in this group successfully completed the surgery.Among them,17 cases underwent laparoscopic combined with open surgery,2 cases underwent complete laparoscopic surgery,and 1 case underwent complete open surgery.Eight cases underwent loop ileostomy stoma closure first:3 cases underwent IPOM repair,1 case underwent open surgery for Sublay repair,and 4 cases underwent displaced permanent colostomy with simple suturing repair.Nine patients underwent reconstruction of double lumen stoma into single lumen stoma before hernia repair,including 5 cases of Sugarbaker repair,1 case of Keyhole repair,and 3 cases of simple suture repair.Three patients underwent laparoscopic repair of hernia while preserving the double lumen stoma.Conclusion The recommended treatment options for double lumen parastomal hernia include hernia repair after the stoma closure,changing to single lumen stoma for hernia repair,and retaining the double lumen stoma for hernia repair.Surgical recommendation is to place a mesh under laparoscopy to repair abdominal wall defects.