探讨腹腔镜与开放杂交应用Sublay&Onlay-Keyhole术原位修补造口旁疝的方法及疗效。

2017年5月至2019年5月，解放军总医院第四医学中心采用腹腔镜与开放杂交应用Sublay&Onlay-Keyhole术原位修补造口旁疝11例。患者均为永久性造瘘，其中8例为低位直肠癌行Miles术式后的乙状结肠末端造瘘，3例为膀胱癌行回肠代膀胱术后的回肠末端造瘘。2例患者既往曾行造口旁疝修补术后复发。末次术后3.5~4.0年，平均3.75年。疝环最长径为4~8 cm，平均5.55 cm。

11例均以腹腔镜与开放杂交应用Sublay&Onlay-Keyhole术成功完成腹壁重建手术。手术时间110~190 min，平均141.55 min；术后住院时间6~18 d，平均10 d。术后患者切口均Ⅰ期愈合，无肠瘘及腹壁感染发生。2例（18.2%）发生血清肿。随访时间6~23个月，平均随访14.55个月。11例患者术后未见造口旁疝复发或发生其他切口疝。

腹腔镜与开放杂交应用Sublay&Onlay-Keyhole术原位修补造口旁疝是腹壁重建的有效方法，具有复发率低、并发症少等优点，但远期疗效仍需进一步观察随访。

To investigate the procedure and the effectiveness of laparoscopic and open hybrid application of Sublay&Onlay-Keyhole in situ repair of parastomal hernia.

Between May 2017 and May 2019, 11 patients with parastomal hernia in the Fourth Medical Center of PLA General Hospital underwent laparoscopic and open hybrid application of Sublay&Onlay-Keyhole technique in situ repair. All stomas of patients were permanent, including 8 cases with end colostomies following Miles operation for low rectal cancer, and 3 cases with end ileostomies following ileal conduit for bladder cancer. Two patients had recurrence after previous parastomal hernia repair. The average time from last operation was 3.75 years (range, 3.5 to 4.0 years). The average longest diameter of hernia ring was 5.55 cm (range, 4 to 8 cm).

Reconstructions of abdominal wall in all 11 patients were performed successfully through laparoscopic and open hybrid application of Sublay&Onlay-Keyhole technique. The average operative time was 141.55 minutes (range, 110 to 190 minutes) and the average postoperative hospitalization days were 10 days (range, 6 to 18 days). All patients achieved healing of incision by first intention with no intestinal fistula or abdominal wall infection. Seroma occurred in 2 patients (18.2%). All patients were followed up 14.55 months on average (range, 6 to 23 months). No parastomal hernia recurrence or incisional hernia occurred in the 11 patients.

Laparoscopic and open hybrid application of Sublay&Onlay-Keyhole in situ repair of parastomal hernia is an effective procedure for reconstruction of abdominal wall, which has the advantages of low recurrence rate and less complications. But the long-term effectiveness needs further observation and follow-up.