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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) ›› 2022, Vol. 16 ›› Issue (06) : 644 -648. doi: 10.3877/cma.j.issn.1674-392X.2022.06.008

临床论著

Keyhole与Sugarbaker术治疗造口旁疝单中心十年疗效对比
王金申1, 刘景磊1, 石玉龙1,†()   
  1. 1. 250021　济南，山东第一医科大学附属山东省立医院胃肠外科
  • 收稿日期:2022-05-03 出版日期:2022-12-18
  • 通信作者: 石玉龙
  • 基金资助:
    山东省自然科学基金(ZR2020MH221); 济南市临床医学创新计划(201704128)

Comparison effect of Keyhole and Sugarbaker treatment for parastomal hernia for 10 years in single-center

Jinshen Wang1, Jinglei Liu1, Yulong Shi1,†()   

  1. 1. Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
  • Received:2022-05-03 Published:2022-12-18
  • Corresponding author: Yulong Shi
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王金申, 刘景磊, 石玉龙. Keyhole与Sugarbaker术治疗造口旁疝单中心十年疗效对比[J]. 中华疝和腹壁外科杂志(电子版), 2022, 16(06): 644-648.

Jinshen Wang, Jinglei Liu, Yulong Shi. Comparison effect of Keyhole and Sugarbaker treatment for parastomal hernia for 10 years in single-center[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2022, 16(06): 644-648.

目的

探讨造口旁疝不同手术方式的治疗效果。

方法

回顾性分析2012-2022年山东省立医院收治的102例采用Keyhole或Sugarbaker术式进行造口旁疝修补患者的临床资料，其中Keyhole术40例，Sugarbaker术62例，根据是否为腹腔镜辅助又分为开放组21例，腔镜组81例。观察不同手术组在手术时间、住院时间、术中出血量、术后胃肠功能恢复时间以及腹胀、疼痛、切口感染、肠漏、肠梗阻、肠坏死等并发症，并随访术后复发情况。

结果

手术时间：Keyhole组较Sugarbaker组长（P<0.05），开放组较腔镜组长（P<0.05）；腹胀发生率：开放组显著高于腔镜组（P<0.05）；其余指标虽有差异，但无统计学意义。

结论

无论采用Keyhole还是Sugarbaker术式、开放或腹腔镜手术进行造口旁疝修补，在严重并发症和复发率方面都是相似的，采用Sugarbaker术较Keyhole术手术时间更短，Keyhole组复发率高，但差异无统计学意义。开放手术用时更长，术后腹胀情况更重。

关键词: 造口旁疝, 疝修补术, 疗效
Objective

To investigate the therapeutic effect of different surgical methods for parastomal hernia.

Methods

Clinical data from 102 patients treated with Keyhole or Sugarbaker surgery for parastomal hernia repair at Shandong Provincial Hospital over the last ten years (2012-2022) were analyzed retrospectively, with 40 patients treated with Keyhole surgery and 62 patients treated with Sugarbaker surgery. According to whether it was laparoscopically assisted or not, the patients were divided into an open surgery group (21 cases) and a laparoscopic surgery group (81 cases). The operation time, hospital stay, intraoperative blood loss, postoperative gastrointestinal function recovery time, abdominal distension, pain, incision infection, intestinal leakage, intestinal obstruction, intestinal necrosis and other complications in different operation groups were observed, and postoperative recurrence was followed up.

Results

The operation time in the Keyhole surgery group was longer than that in the Sugarbaker surgery group, and that in open surgery group was longer than that in the laparoscopic surgery group. Meanwhile, the incidence of abdominal distension in the open surgery group was significantly higher than that in the laparoscopic surgery group. Although there were differences in other indicators, there was no statistical significance.

Conclusion

The Keyhole or Sugarbaker procedures were similar in terms of severe complications and recurrence regardless of whether they were performed with open or laparoscopic surgery, but the open surgery took longer, the postoperative abdominal distension was more severe, and the Sugarbaker procedure took less time than the Keyhole group. Although the recurrence rate of the Keyhole group was high, it did not reach statistical significance. The open procedure took longer, and the postoperative abdominal distension was heavier.

Key words: Parastomal hernia, Hernia repair, Treatment effect
表1 Keyhole组与Sugarbaker组一般资料比较[例（%）]
组别 例数 性别 年龄(岁,±s) BMI(kg/m2,±s) ASA分级 造口分类 EHS造口旁疝分型 糖尿病 开放 腔镜
男性 女性 Ⅰ Ⅱ Ⅲ 回肠代膀胱造口 结肠造口 Ⅰ Ⅱ Ⅲ Ⅳ
Keyhole 40 20(50.0) 20(50.0) 67.7±9.8 26.7±3.6 8(20.0) 26(65.0) 6(15.0) 1 ( 2.5) 39(97.5) 22(55.0) 5(12.5) 11(27.5) 2(5.0) 12(30.0) 13(32.5) 27(67.5)
Sugarbaker 62 35(56.5) 27(43.5) 65.6±9.1 26.3±3.7 15(24.2) 41(66.1) 6( 9.7) 10(16.1) 52(83.9) 31(50.0) 4( 6.4) 21(33.8) 6(9.8) 32(51.6) 8(12.9) 54(87.1)
t/χ2   0.407 1.102 0.543 0.780 4.694 2.118 4.630 5.711
P   0.523 0.265 0.588 0.677 0.030 0.548 0.031 0.017
表2 开放组与腔镜组一般资料比较[例（%）]
组别 例数 性别 年龄(岁,±s) BMI (kg/m2,±s) ASA分级 造口分类 EHS造口旁疝分型 糖尿病 Keyhole Sugarbaker
男性 女性 Ⅰ Ⅱ Ⅲ 回肠代膀胱造口 结肠造口 Ⅰ Ⅱ Ⅲ Ⅳ
开放 21 14(66.7) 7(33.3) 66.5±10.3 25.3±4.6 2( 9.5) 18(85.7) 1( 4.8) 0 21(100.0) 9(52.8) 3(14.3) 7(33.4) 2(9.5) 6(28.6) 13(61.9) 8(38.1)
腔镜 81 41(50.6) 40(49.4) 66.4± 9.2 26.8±3.4 21(25.9) 49(60.5) 11(13.6) 11(13.6) 70( 86.4) 44(54.3) 6( 7.4) 25(30.9) 6(7.4) 38(46.9) 27(33.3) 54(66.7)
t/χ2   1.729 0.040 1.708 4.707 4.374 1.444 1.244 5.711
P   0.189 0.97 0.154 0.095 0.037 0.695 0.265 0.017
表3 不同组别手术相关指标比较（±s）
组别 例数 手术时间(min) 术中出血量(ml) 胃肠功能恢复时间(d) 住院时间(d)
Keyhole 40 205.3±67.4 43.5±49.2 3.3±1.5 12.2±5.8
Sugarbaker 62 155.8±57.7 27.3±28.6 3.4±1.2 10.5±3.8
t   3.957 2.104 0.266 1.766
P值   0.001 0.064 0.799 0.112
开放 21 208.2±78.3 43.5±49.2 3.7±1.6 12.6±5.1
腔镜 81 166.6±60.1 27.3±28.6 3.2±1.3 10.7±4.6
t   2.647 2.949 1.680 1.841
P值   0.032 0.083 0.144 0.094
表4 不同组别术后并发症及随访情况比较[例（%）]
组别 例数 腹胀 疼痛 切口感染 肠漏 肠梗阻 肠坏死 复发 失访/死亡
Keyhole 40 21(52.5) 36(90.0) 1(2.5) 1(2.5) 4(10.0) 0 6(15.0) 8(20.0)
Sugarbaker 62 36(58.1) 58(93.5) 3(4.8) 2(3.2) 2( 3.2) 1(1.6) 8(12.9) 18(29.0)
χ2   0.301 0.424 0.353 0.045 2.015 1.503 1.371 -
P   0.581 0.515 0.552 0.832 0.156 0.22 0.592 -
开放 21 16(76.2) 20(95.2) 2(9.5) 1(4.8) 2(9.5) 0 5(23.8) 4(19.0)
腔镜 81 41(50.6) 74(91.4) 2(2.4) 2(2.5) 4(4.9) 1(1.2) 9(11.1) 22(27.2)
χ2   4.424 0.347 2.203 0.307 0.633 0.262 2.322 -
P   0.035 0.556 0.138 0.556 0.426 0.609 0.294 -
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