切换至 "中华医学电子期刊资源库"

中华疝和腹壁外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (06) : 561 -565. doi: 10.3877/cma.j.issn.1674-392X.2021.06.005

临床论著

腔镜腹膜外补片修补技术治疗造口旁疝
李炳根1,(), 余旭辉2, 庄波3, 罗宏宇4, 张博5, 徐福明6, 周诚亮2   
  1. 1. 511400 广州,南方医科大学附属何贤纪念医院普通外科
    2. 330700 江西省奉新县中医院外一科
    3. 321000 浙江省,金华市中心医院胃肠疝外科
    4. 516211 广东省,惠州市第六人民医院普通外科
    5. 712000 陕西省咸阳市第一人民医院胃肠外科
    6. 561100 贵州省安顺市平坝区人民医院胃肠甲乳疝外科
  • 收稿日期:2021-11-12 出版日期:2021-12-20
  • 通信作者: 李炳根
  • 基金资助:
    吴阶平医学基金会临床科研专项资助基金(320.6750.18393)

Innovative approaches for parastomal hernia: lap-endoscopic sublay/ extraperitoneal mesh repair

Binggen Li1,(), Xuhui Yu2, Bo Zhuang3, Hongyu Luo4, Bo Zhang5, Fuming Xu6, Chengliang Zhou2   

  1. 1. Department of General Surgery, Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou 511400, China
    2. Department of General Surgery, Fengxin ChineseTraditional Medicine Hospital, Yichun 330700, China
    3. Department of General Surgery, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, China
    4. Department of General Surgery, The sixth People’s Hospital of Huizhou, Huizhou 516211, China
    5. Department of Gastrointestinal Surgery, The first People's Hospital of Xianyang, Xianyang 712000, China
    6. Department of General Surgery, Pingba District People's Hospital of Anshun City, Anshun 561100, China
  • Received:2021-11-12 Published:2021-12-20
  • Corresponding author: Binggen Li
引用本文:

李炳根, 余旭辉, 庄波, 罗宏宇, 张博, 徐福明, 周诚亮. 腔镜腹膜外补片修补技术治疗造口旁疝[J/OL]. 中华疝和腹壁外科杂志(电子版), 2021, 15(06): 561-565.

Binggen Li, Xuhui Yu, Bo Zhuang, Hongyu Luo, Bo Zhang, Fuming Xu, Chengliang Zhou. Innovative approaches for parastomal hernia: lap-endoscopic sublay/ extraperitoneal mesh repair[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2021, 15(06): 561-565.

目的

系统性探索腔镜腹直肌后/腹腔镜经腹腹膜前疝修补术(TES/TAPP)在造口旁疝治疗的可行性和相关细节。

方法

回顾性分析2020年12月至2021年7月,南方医科大学附属何贤纪念医院、奉新县中医院、金华市中心医院、惠州市第六人民医院、咸阳市第一人民医院及安顺市平坝区人民医院完成的6例结肠造口旁疝患者的资料,分析原来手术方式与当前疝修补手术方式的关系,记录手术细节,总结相关经验。

结果

6例患者中,行TES术式4例,其中Sugarbaker补片放置者3例,Keyhole补片1例;TAPP术式2例,均为Sugarbaker补片放置。补片使用面积为(246.0±26.0)cm2。手术时间(220.0±29.0)min,出血量均很少。所有手术均能顺利完成,无血管或者内脏损伤,无中转手术,其中2例患者需要进行造口重做。术后疼痛轻,术后第1天静息视觉模拟评分法评分(3.3±0.8)分,术后造口排气时间(2.6±0.5)d,术后住院时间(8.0±2.8)d。所有患者均获得随访,随访时间3~10个月,术后造口以及腹壁外观均满意,未见疝复发病例,无术后慢性疼痛,未发现补片感染。1例造口重做患者出现造口伤口感染,经引流后痊愈。

结论

TES/TAPP治疗造口旁疝技术上安全可行,但技术难度大,适应证有限,仍需更大样本更长时间随访的研究来验证。

Objective

To systematic explore the technical feasibility and details of lap-endoscopic sublay/ trans-abdominal preperitoneal patch repair (TES/TAPP) for parastomal hernia.

Methods

Six parastomal hernia patients were enrolled in He Xian Memorial Hospital Affiliated to Southern Medical University, Fengxin County Traditional Chinese Medicine Hospital, Jinhua Central Hospital, Huizhou Sixth People's Hospital, Xianyang First People's Hospital and Pingba District People's Hospital of Anshun City from December 2020 to October 2021. Patients' demographics and perioperative details were retrospectively collected and analyzed. The association of original surgical method and current hernia repair method was analyzed. The operation details were recorded and experiences were summarized.

Results

Four patients were performed by TES mesh repair. Among them, the meshes were deployed with Sugarbaker configuration in 3 patients and Keyhole pattern in 1 patient. Two patients were operated by TAPP repair in a Sugarbaker configuration. The mean mesh size used was (246.0±26.0) cm2. The mean operative time was (220.0±29.0) min. The blood loss was minimum. All operations were successful without vascular or visceral damage or conversion. Two patients underwent stoma reconstruction. The postoperative pain was minimum. The mean pain visual analogue score at rest on day 1 was (3.3±0.8) points. The average stoma exhaust time was (2.6±0.5) days. The average postoperative stay was (8.0±2.8) days. All patients were followed for 3 to 10 months. Patients were satisfied with postoperative stoma and abdominal wall appearance. There was no recurrence, no postoperative chronic pain, no mesh infection. One patient with stoma reconstruction developed a stomal wound infection, and she was cured after drain replacement and wound debridement.

Conclusion

The TES/TAPP techniques for parastomal hernia repair are safe and technically feasible. The indication for these techniques is limited so the true efficacy remain to be explored. Owing to the technically challenging property, these techniques are destined to be the armamentarium of few skilled hands.

图2 造口内侧的肌后(Sublay)间隙与外侧腹膜外(Bogros)间隙分离
图4 造口重做,缺损予以PDS线关闭
图6 腹膜外间隙的Sugarbaker修补,少量固定即可
图7 造口旁疝TES/TAPP手术中补片Sugarbaker置放示意图
图8 Sugarbaker修补前,可以小补片加固造口肠管后方的侧腹壁
[1]
Antoniou SA, Agresta F, Garcia Alamino JM, et al. European Hernia Society guidelines on prevention and treatment of parastomal hernias[J]. Hernia, 2018, 22(1): 183-198.
[2]
Hansson BM, van Nieuwenhoven EJ, Bleichrodt RP. Promising new technique in the repair of parastomal hernia[J]. Surg Endosc, 2003, 17(11): 1789-1791.
[3]
Mancini GJ, McClusky DA 3rd, Khaitan L, et al. Laparoscopic parastomal hernia repair using a nonslit mesh technique[J]. Surg Endosc, 2007, 21(9): 1487-1491.
[4]
Berger D, Bientzle M. Laparoscopic repair of parastomal hernias: a single surgeon's experience in 66 patients[J]. Dis Colon Rectum, 2007, 50(10): 1668-1673.
[5]
Reinpold W, Schröder M, Berger C, et al. Mini- or less-open Sublay operation(MILOS): a new minimally invasive technique for the extraperitoneal mesh repair of incisional hernias[J]. Ann Surg, 2019, 269(4): 748-755.
[6]
Schwarz J, Reinpold W, Bittner R. Endoscopic mini/less open Sublay technique(EMILOS)-a new technique for ventral hernia repair[J]. Langenbecks Arch Surg, 2017, 402(1): 173-180.
[7]
Belyansky I, Daes J, Radu VG, et al. A novel approach using the enhanced-view totally extraperitoneal(eTEP) technique for laparoscopic retromuscular hernia repair[J]. Surg Endosc, 2018, 32(3): 1525-1532.
[8]
Prasad P, Tantia O, Patle NM, et al. Laparoscopic transabdominal preperitoneal repair of ventral hernia: a step towards physiological repair[J]. Indian J Surg, 2011, 73(6): 403-408.
[9]
汤睿,吴卫东,蒋会勇, 等. 内镜下经腹Sublay修补术在腹壁疝治疗中的应用[J/OL]. 中华腔镜外科杂志(电子版), 2020, 13(4): 212-217.
[10]
Li B, Qin C, Bittner R. Totally endoscopic sublay(TES) repair for midline ventral hernia: surgical technique and preliminary results[J]. Surg Endosc, 2020, 34(4): 1543-1550.
[11]
Li B, Qin C, Yu J, et al. Totally endoscopic sublay(TES) repair for lateral abdominal wall hernias: technique and first results[J]. Hernia, 2021, 25(2): 523-533.
[12]
吴卫东,蒋会勇,孟相真, 等. 内镜下全腹膜外Sublay修补在腹壁疝中的应用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2021, 15(1): 12-18.
[13]
李炳根. 内镜下全内脏囊分离技术:腹壁疝微创新理念[J]. 中华消化外科杂志, 2019, 18(11): 1022-1026.
[14]
Li B, Qin C, Luo H, Li G. Totally endoscopic sublay/extraperitoneal Sugarbaker mesh repair for parastomal hernia[J]. 2021.
[15]
李炳根,李颖,龚独辉, 等. 增强视野完全腹膜外疝修补术在下腹疝患者中的应用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2018, 12(5): 363-366.
[16]
Pauli EM, Juza RM, Winder JS. How I do it: novel parastomal herniorrhaphy utilizing transversus abdominis release[J]. Hernia, 2016, 20(4): 547-552.
[17]
Tastaldi L, Haskins IN, Perez AJ, et al. Single center experience with the modified retromuscular Sugarbaker technique for parastomal hernia repair[J]. Hernia, 2017, 21(6): 941-949.
[18]
Sosin M, Nahabedian MY, Bhanot P. The perfect plane: a systematic review of mesh location and outcomes, update 2018[J]. Plast Reconstr Surg, 2018, 142(3 Suppl): 107S-116S.
[19]
Bui NH, Jørgensen LN, Jensen KK. Laparoscopic intraperitoneal versus enhanced-view totally extraperitoneal retromuscular mesh repair for ventral hernia: a retrospective cohort study[J]. Surg Endosc, 2021. Online ahead of print.
[20]
Imamura K, Takada M, Umemoto K, et al Laparoscopic parastomal herniorrhaphy utilizing transversus abdominis release and a modified Sugarbaker technique: a case report[J]. Asian J Endosc Surg, 2021, 14(1): 106-108.
[21]
Lambrecht JR. Endoscopic preperitoneal parastomal hernia repair(ePauli repair): an observational study[J]. Surg Endosc, 2021, 35(4): 1903-1907.
[22]
Jiang H, Thapa DM, Ma C, et al. Endoscopic totally extraperitoneal repair of parastomal hernia: a case report[J]. Front Surg, 2021, 8: 659102.
[23]
马宁,胡志伟,曾德强, 等. 腹腔镜下经腹腔腹膜前造口旁疝Sugarbaker修补术[J]. 中华胃肠外科杂志, 2021, 24(8): 652.
[1] 燕速, 霍博文. 腹腔镜食管胃结合部腺癌根治性切除术[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 13-13.
[2] 母德安, 李凯, 张志远, 张伟. 超微创器械辅助单孔腹腔镜下脾部分切除术[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 14-14.
[3] 李国新, 陈新华. 全腹腔镜下全胃切除术食管空肠吻合的临床研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 1-4.
[4] 李子禹, 卢信星, 李双喜, 陕飞. 食管胃结合部腺癌腹腔镜手术重建方式的选择[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 5-8.
[5] 李乐平, 张荣华, 商亮. 腹腔镜食管胃结合部腺癌根治淋巴结清扫策略[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 9-12.
[6] 陈方鹏, 杨大伟, 金从稳. 腹腔镜近端胃癌切除术联合改良食管胃吻合术重建His角对术后反流性食管炎的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 15-18.
[7] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[8] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[9] 任佳, 马胜辉, 王馨, 石秀霞, 蔡淑云. 腹腔镜全胃切除、间置空肠代胃术的临床观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 31-34.
[10] 王庆亮, 党兮, 师凯, 刘波. 腹腔镜联合胆道子镜经胆囊管胆总管探查取石术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 313-313.
[11] 杨建辉, 段文斌, 马忠志, 卿宇豪. 腹腔镜下脾部分切除术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 314-314.
[12] 叶劲松, 刘驳强, 柳胜君, 吴浩然. 腹腔镜肝Ⅶ+Ⅷ段背侧段切除[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 315-315.
[13] 郭兵, 王万里, 何凯, 黄汉生. 腹腔镜下肝门部胆管癌根治术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 143-143.
[14] 李凯, 陈淋, 苏怀东, 向涵, 张伟. 超微创器械在改良单孔腹腔镜巨大肝囊肿开窗引流及胆囊切除中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 144-144.
[15] 魏丽霞, 张安澜, 周宝勇, 李明. 腹腔镜下Ⅲb型肝门部胆管癌根治术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 145-145.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?