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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 (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
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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]. 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]. 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。

关键词: 造口旁疝, 腹腔镜, 全腹膜外, 疝修补术, 全内脏囊分离
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.

Key words: Parastomal hernia, Laparoscopes, Totally extraperitoneal, Herniorrhaphy, Totally visceral sac separation
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
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