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中华疝和腹壁外科杂志(电子版)

中华疝和腹壁外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (05) : 455 -458. doi: 10.3877/cma.j.issn.1674-392X.2021.05.004

临床论著

造口旁疝Sublay-Keyhole原位修补术的疗效
孟相真1, 徐琨1, 杨福全1,†()   
  1. 1. 110004　沈阳，中国医科大学附属盛京医院普通外科
  • 收稿日期:2020-04-06 出版日期:2021-10-14
  • 通信作者: 杨福全
  • 基金资助:
    国家科技支撑计划课题(2015BAI13B09)

Efficacy of Sublay-Keyhole in situ repair of parastoma hernia

Xiangzhen Meng1, Kun Xu1, Fuquan Yang1,†()   

  1. 1. Department of General Surgery, Colon Rectum, Hernia and Minimum Invasive Surgery Ward, Shengjing Hospital of China Medical University, Shenyang 110004, China
  • Received:2020-04-06 Published:2021-10-14
  • Corresponding author: Fuquan Yang
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引用本文：

孟相真, 徐琨, 杨福全. 造口旁疝Sublay-Keyhole原位修补术的疗效[J]. 中华疝和腹壁外科杂志(电子版), 2021, 15(05): 455-458.

Xiangzhen Meng, Kun Xu, Fuquan Yang. Efficacy of Sublay-Keyhole in situ repair of parastoma hernia[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2021, 15(05): 455-458.

目的

探讨采用一种造口原位Sublay-Keyhole的新技术修补造口旁疝的疗效。

方法

选取2018年1月至2019年12月于中国医科大学附属盛京医院确诊为合并切口疝行造口旁疝修补术患者12例。其中，男性7例，女性5例；年龄59~81岁，平均68.8岁；体质量指数21.5~28.9 kg/m2，平均25.5 kg/m2。所有患者行造口旁疝Sublay-Keyhole原位修补术。

结果

直肠癌患者行永久性结肠造口术10例，结肠癌患者行永久性结肠造口术1例，结肠穿孔患者行永久性回肠造口术1例。全造口为经腹直肌型，右下腹位2例，左下腹位10例。1例患者曾行单纯缝合修补后复发。缺损直径6~12 cm，平均直径9.7 cm。所有患者均为Ⅲ型疝。术后住院3~9 d，平均6.6 d。随访5~14个月，平均9.5个月，所有患者均无复发，无血肿、血清肿、脱垂、狭窄、网片感染及切口感染等并发症发生。

结论

应用Sublay-Keyhole方式原位修补造口旁疝，效果显著，同时操作简单，费用明显降低，值得进一步推广。

关键词: 造口旁疝, 疝修补术, Sublay-Keyhole, 造口入路
Objective

To explore the effect of using a new technique of in situ Sublay-Keyhole to repair parastoma hernia.

Methods

From January 2018 to December 2019, 12 patients diagnosed with incisional hernia underwent parastomy hernia repair in Shengjing Hospital Affiliated to China Medical University were selected. Among them, 7 were males and 5 were females. Their ages ranged from 59 to 81 years old, with an average age of 68.8 years old. Body mass index (BMI) ranged from 21.5 to 28.9 kg/m2, with an average BMI of 25.5 kg/m2. All patients underwent Sublay-Keyhole in situ repair of parastoma hernia.

Results

Ten patients with rectal cancer underwent permanent colostomy, one patient with colon cancer underwent permanent colostomy, and one patient with colon perforation underwent permanent ileostomy. The total stoma was transrectus abdominis type, with 2 cases in the right lower abdomen and 10 cases in the left lower abdomen. One patient had a relapse after simple suture repair. The diameter of the defect was 6 to 12 cm, with an average diameter of 9.7 cm. All patients had type Ⅲ hernia. The postoperative hospital stay was 3-9 days, with an average of 6.6 days. The follow-up period was 5 to 14 months, with an average of 9.5 months. All patients had no recurrence, and no complications such as hematoma, seroma, prolapse, stenosis, mesh infection, and incision infection occurred.

Conclusion

The application of Sublay-Keyhole method in situ repair of parastoma hernia has significant effect, simple operation and,significantly reduced cost, which is worthy of further promotion.

Key words: Parastomal hernia, Herniorrhaphy, Sublay-Keyhole, Stoma approach
表1 患者的基本信息
患者 年龄(岁)/性别 体质量指数(kg/m2) 造口类型/大小 造口原因 缺损最大径(cm×cm) 前次造口旁疝修补 基础疾病 化疗
1 65/M 23.4 EC/TR,LL RC 6×3     是
2 81/F 23.1 EC/TR,LL RC 10×4 Keyhole CB 是
3 61/F 22.6 EC/TR,LL CC 7×4.5 单纯缝合   是
4 59/F 27.3 EC/TR,LL RC 11×5      
5 66/F 26.7 EI/TR,LR 结肠穿孔 10×6   NS  
6 78/F 21.5 EC/TR,LL RC 12×7.5   BH 是
7 68/M 26.5 EC/TR,LR RC 10×5   淋巴瘤 是
8 63/M 28.9 EC/TR,LL RC 9×5.5      
9 70/M 25.8 EC/TR,LL RC 8×4   BH 是
10 72/M 27.1 EC/TR,LL RC 12×7     是
11 67/M 25.1 EC/TR,LL RC 10×6      
12 76/M 27.7 EC/TR,LL RC 11×5   DM  
表2 患者的术后信息
患者 麻醉评分 手术时间(min) 补片类型 疼痛评分(分) 住院时间(d) 随访时间(个月) 并发症
1 2 65 SeprameshTM 2 3 14 -
2 3 120 SeprameshTM 2 5 13 -
3 2 110 SeprameshTM 3 8 5 -
4 2 75 SeprameshTM 3 5 12 -
5 3 120 SeprameshTM 3 8 9 -
6 2 70 SeprameshTM 2 7 6 -
7 3 70 SeprameshTM 2 8 6 -
8 3 90 SeprameshTM 3 9 10 -
9 3 100 SeprameshTM 3 6 11 -
10 2 85 SeprameshTM 3 7 11 -
11 2 100 SeprameshTM 4 6 9 -
12 3 70 SeprameshTM 2 7 8 -
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