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) ›› 2024, Vol. 18 ›› Issue (03) : 262 -265. doi: 10.3877/cma.j.issn.1674-392X.2024.03.006

论著

膀胱切除术后造口旁疝的治疗
许熠1, 邵翔宇2, 李俊生2,()   
  1. 1. 210009 南京,东南大学医学院
    2. 210009 南京,东南大学附属中大医院普外科
  • 收稿日期:2024-05-20 出版日期:2024-06-18
  • 通信作者: 李俊生

Treatment of parastomal hernia after cystectomy for bladder

Yi Xu1, Xiangyu Shao2, Junsheng Li2,()   

  1. 1. Department of Medical, Southeast University, Nanjing 210009, China
    2. Department of General Surgery, Affiliated Zhongda Hospital, Southeast University, Nanjing, 210009, China
  • Received:2024-05-20 Published:2024-06-18
  • Corresponding author: Junsheng Li
引用本文:

许熠, 邵翔宇, 李俊生. 膀胱切除术后造口旁疝的治疗[J]. 中华疝和腹壁外科杂志(电子版), 2024, 18(03): 262-265.

Yi Xu, Xiangyu Shao, Junsheng Li. Treatment of parastomal hernia after cystectomy for bladder[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(03): 262-265.

目的

探究膀胱切除术后造口旁疝手术修复方式及其有效性。

方法

2020—2024年东南大学附属中大医院共对4例膀胱切除术后造口旁疝进行手术修补,其中回肠代膀胱造口旁疝3例,输尿管造口旁疝1例。

结果

4例患者造口旁腹壁缺损大小不一,根据患者具体情况选择合适术式,手术顺利。Sugarbaker法修补2例,均使用腹腔镜修补;Keyhole法修补2例,其中开放手术1例,使用腹腔镜1例。术后均未见血肿、血清肿、手术相关感染等术后并发症;术后随访2年,随访期间均未出现复发、补片感染、慢性疼痛。

结论

膀胱切除术后造口旁疝的修复方式、补片置入层次需根据患者具体情况进行选择或联合应用,不同术式均具有安全有效性,临床结果理想。

Objective

To investigate the surgical repair method of parastomal hernia after cystectomy for bladder and its effectiveness.

Methods

From 2020 to 2024, a total of 4 cases of parastomal hernia after bladder cystectomy were surgically repaired in Affiliated Zhongda Hospital, Southeast University, including 3 cases of ileostomy hernia and 1 case of ureterostomy hernia.

Results

The size of the parastomal abdominal wall defects varied among the 4 patients, and appropriate surgical procedures were selected according to the specific conditions of the patients, and the operation went smoothly: 2 cases were repaired by Sugarbaker's method, both of which were repaired by laparoscopy; 2 cases were repaired by keyhole method, of which 1 was open and 1 was repaired by laparoscopy. There were no postoperative complications such as hematoma, seroma, or surgery-related infections in any of the cases. The patients were followed up for 2 years after surgery, and no recurrence, mesh infection, or chronic pain occurred during the follow-up period.

Conclusion

The method of repair of parastomal hernia after cystectomy and the level of mesh placement should be selected or combined according to the patient's specific situation, and the different surgical procedures are safe and effective, with ideal clinical outcomes.

图1A 回肠代膀胱的造口旁疝外观  图1B CT显示回肠代膀胱造口旁疝和切口疝,两处缺损  图1C 腹腔镜手术当中,见造口旁疝和切口疝两处缺损,均有肠管疝入  图1D 采用Sugarbaker手术方式,修补造口旁疝,同时修补切口疝缺损
图2A 回肠代膀胱的术后造口旁疝  图2B 腹腔镜Sugarbaker造口旁疝修补术
图3 回肠代膀胱造口旁疝修补术(Onlay术式)
图4A 右侧巨大输尿管造口旁疝外观  图4B 术中显示巨大造口旁疝缺损,其中可见输尿管走行,输尿管有所扩张  图4C 完成右侧输尿管造口旁疝修补术(Sugarbaker术式)
[1]
Carne PW, Robertson GM, Frizelle FA. Parastomal hernia[J]. Br J Surg, 2003, 90(7): 784-793.
[2]
Ghoreifi A, Allgood E, Whang G, et al. Risk factors and natural history of parastomal hernia after radical cystectomy and ileal conduit[J]. BJU Int, 2022, 130(3): 381-388.
[3]
Robin Valle de Lersundi A, Rupealta N, San Miguel Mendez C, et al. High recurrence rate after posterior component separation and keyhole mesh reconstruction for complex parastomal hernia: A case series study[J]. Colorectal Dis, 2021, 23(8): 2137-2145.
[4]
Rezaee ME, Goldwag JL, Goddard B, et al. Parastomal hernia development after cystectomy and ileal conduit for bladder cancer: results from the Dartmouth ileal conduit enhancement(DICE) project[J]. Can J Urol, 2020, 27(5): 10369-10377.
[5]
Donahue TF, Bochner BH. Parastomal hernias after radical cystectomy and ileal conduit diversion[J]. Investig Clin Urol, 2016, 57(4): 240-248.
[6]
Mäkäräinen-Uhlbäck E, Vironen J, Vaarala M, et al. Keyhole versus Sugarbaker techniques in parastomal hernia repair following ileal conduit urinary diversion: a retrospective nationwide cohort study[J]. BMC Surg, 2021, 21(1): 231.
[7]
Fleming AM, Phillips AL, Drake JA, et al. Sugarbaker Versus Keyhole Repair for Parastomal Hernia: Results of an Artificial Intelligence Large Language Model Post Hoc Analysis[J]. J Gastrointest Surg, 2023, 27(11): 2567-2570.
[8]
Narang SK, Alam NN, Campain NJ, et al. Parastomal hernia following cystectomy and ileal conduit urinary diversion: a systematic review[J]. Hernia, 2017, 21(2): 163-175.
[9]
Goffioul L, Bonnet P, Waltregny D, et al. Parastomal hernia after radical cystectomy with ileal conduit diversion: a narrative review[J]. Acta Chir Belg, 2021, 121(6): 373-379.
[10]
Yan Z, Zhang H, Zhan H, et al. The modified laparoscopic keyhole parastomal hernia repair with in situ re-ostomy has low recurrence rate[J]. Hernia, 2018, 22(4): 685-690.
[11]
Dewulf M, Pletinckx P, Nachtergaele F, et al. How-I-do-it: minimally invasive repair of ileal conduit parastomal hernias[J]. Langenbecks Arch Surg, 2022, 407(3): 1291-1301.
[12]
Laycock J, Troller R, Hussain H, et al. A keyhole approach gives a sound repair for ileal conduit parastomal hernia[J]. Hernia, 2022, 26(2): 647-651.
[13]
Gameza VA, Bell Lybecker M, Wara P. Laparoscopic Keyhole Versus Sugarbaker Repair in Parastomal Hernia: A Long-Term Case-Controlled Prospective Study of Consecutive Patients[J]. J Laparoendosc Adv Surg Tech A, 2020, 30(7): 783-789.
[14]
Chegireddy V, Doval AF, Zavlin D, et al. Parastomal Hernia Repair Using a Silo Biologic Mesh[J]. Ann Plast Surg, 2021, 87(5): e97-e102.
[15]
Styliński R, Alzubedi A, Rudzki S. Parastomal hernia-current knowledge and treatment[J]. Wideochir Inne Tech Maloinwazyjne, 2018, 13(1): 1-8.
[16]
Brandsma HT, Hansson BM, V-Haaren-de Haan H, et al. PREVENTion of a parastomal hernia with a prosthetic mesh in patients undergoing permanent end-colostomy; the PREVENT-trial: study protocol for a multicenter randomized controlled trial[J]. Trials, 2012, 13: 226.
[17]
Styrke J, Johansson M, Granåsen G, et al. Parastomal hernia after ileal conduit with a prophylactic mesh: a 10 year consecutive case series[J]. Scand J Urol, 2015, 49(4): 308-312.
[18]
Liedberg F, Kollberg P, Allerbo M, et al. Preventing Parastomal Hernia After Ileal Conduit by the Use of a Prophylactic Mesh: A Randomised Study[J]. Eur Urol, 2020, 78(5): 757-763.
[19]
Salameh JR, Talbott LM, May W, et al. Role of biomarkers in incisional hernias[J]. Am Surg, 2007, 73(6): 561-567; discussion 567-568.
[20]
Rezaee ME, Goldwag JL, Goddard B, et al. Parastomal hernia development after cystectomy and ileal conduit for bladder cancer: results from the Dartmouth ileal conduit enhancement(DICE) project[J]. Can J Urol, 2020, 27(5): 10369-10377.
[1] 段东峰, 王成果, 王青, 王健, 惠立良, 莘玮, 杨媛. 两种造口旁疝修补术的临床效果比较[J]. 中华普外科手术学杂志(电子版), 2023, 17(04): 435-438.
[2] 李萍, 陈慧, 庄君龙. 快速康复外科在机器人辅助腹腔镜膀胱切除回肠造口术中的应用[J]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(03): 249-253.
[3] 王昆, 潘迪, 王庆, 江克华, 孙发. 机器人手术治疗膀胱副神经节瘤一例报告[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(03): 291-292.
[4] 邰胜, 周骏, 施浩强, 杨诚, 尹水平, 牛迪, 郝宗耀, 傅强, 梁朝朝. 无线智能腔镜在腹腔镜膀胱癌根治术中的运用[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(01): 22-25.
[5] 刘化胜, 郑龙波, 秦琛, 王伟芹, 郑学风, 马金龙, 马正, 王洪霞, 刘磊, 胡继霖. 基于影像学指标构建永久性乙状结肠造口旁疝发病风险预测模型[J]. 中华疝和腹壁外科杂志(电子版), 2024, 18(01): 75-82.
[6] 毛永欢, 仝瀚文, 缪骥, 王行舟, 沈晓菲, 喻春钊. 造口旁疝危险因素预测模型构建[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 682-687.
[7] 方红燕, 刘晓昌, 方家旭. 腹部按压联合综合护理在腹壁造口旁疝患者肠镜检查中的应用效果[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(05): 625-629.
[8] 《造口旁疝专家微共识:腹膜外Sugarbaker修补技术》编审委员会, 《中华疝和腹壁外科杂志(电子版)》编辑委员会, 全国卫生产业企业管理协会疝和腹壁外科产业及临床研究分会造口旁疝专家组. 造口旁疝专家微共识:腹膜外Sugarbaker修补技术[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(03): 243-246.
[9] 龚泽众, 朱万骥, 任延英, 徐朝辉, 曲慧, Hyok Ju Ri, 张帆, 邵帅, 陈鑫. 预防性放置补片对预防造口旁疝疗效的Meta分析[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(01): 96-104.
[10] 张泽华, 杨诗怡, 熊茂明, 张嘉炜. 腹盆腔脂肪与肌肉含量与Miles术后发生造口旁疝风险的相关性研究[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(01): 9-14.
[11] 《造口旁疝专家微共识:术前准备和术后处理》编审委员会, 《中华疝和腹壁外科杂志(电子版)》编辑委员会, 全国卫生产业企业管理协会疝和腹壁外科产业及临床研究分会造口旁疝专家组. 造口旁疝专家微共识:术前准备和术后处理[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(01): 3-5.
[12] 《造口旁疝专家微共识:手术适应证及禁忌证》编审委员会, 《中华疝和腹壁外科杂志(电子版)》编辑委员会, 全国卫生产业企业管理协会疝和腹壁外科产业及临床研究分会造口旁疝专家组. 造口旁疝专家微共识:手术适应证及禁忌证[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(01): 1-2.
[13] 仝聪, 王慧, 周哲琦, 李泽雨, 阎立昆, 王小强. 保留后鞘完整的隧道式造口预防造口旁疝疗效分析[J]. 中华疝和腹壁外科杂志(电子版), 2022, 16(06): 649-652.
[14] 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.
[15] 王金申, 朱华, 刘景磊, 石玉龙. 造口旁疝的诊治浅析[J]. 中华疝和腹壁外科杂志(电子版), 2022, 16(06): 624-627.
阅读次数
全文


摘要