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中华疝和腹壁外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (06) : 634 -638. doi: 10.3877/cma.j.issn.1674-392X.2024.06.008

论著

造口还纳术后切口疝的危险因素分析与预防策略
林凯1, 潘勇1, 赵高平1, 杨春1,()   
  1. 1.610072 成都,四川省医学科学院 四川省人民医院(电子科技大学附属医院)胃肠外科
  • 收稿日期:2024-11-05 出版日期:2024-12-18
  • 通信作者: 杨春
  • 基金资助:
    四川省科技厅计划项目(2022YFS0166)

Analysis of risk factors and prevention strategy of incisional hernia after stoma reduction surgery

Kai Lin1, Yong Pan1, Gaoping Zhao1, Chun Yang1,()   

  1. 1.Department of Gastrointestinal Surgery, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China ,Chengdu 610072, China
  • Received:2024-11-05 Published:2024-12-18
  • Corresponding author: Chun Yang
引用本文:

林凯, 潘勇, 赵高平, 杨春. 造口还纳术后切口疝的危险因素分析与预防策略[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 634-638.

Kai Lin, Yong Pan, Gaoping Zhao, Chun Yang. Analysis of risk factors and prevention strategy of incisional hernia after stoma reduction surgery[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(06): 634-638.

目的

分析造口还纳术后造口部位切口疝(SSIH)的临床特点,以期加强临床医生对SSIH 的认识和重视。

方法

回顾性分析2021 年1 月至2023 年5 月,四川省医学科学院 四川省人民医院(电子科技大学附属医院)胃肠外科收治的行结直肠手术+预防性肠造口手术的232 例患者的临床资料。通过随访及影像学检查确诊SSIH,并统计分析发生SSIH 的切口部位相关临床特点。

结果

在232 例患者中共有30 例(12.9%)发生SSIH。比较不同结局患者的临床特征,结果显示,SSIH 患者合并造口旁疝、术后发生切口感染、造口直径>2.5 cm、还纳时是否离断肌肉、缝合时的技术等与未发生SSIH 的患者相比,差异均有统计学意义(P<0.05)。合并造口旁疝、还纳后切口感染、造口直径>2.5 cm、间断缝合、离断肌肉是预防性造口还纳术后发生SSIH 的独立危险因素[优势比分别为10.31、15.17、5.348、8.203、4.671;95%可信区间分别为(2.680~45.210)、(4.716~57.180)、(1.751~18.380)、(2.338~37.880)、(1.427~18.910)]。

结论

避免预防性造口过大,防止造口旁疝的出现,还纳时避免切口感染,还纳造口时减少肌肉的离断,缝合切口时采取连续缝合等措施有助于减少SSIH 的发生。

Objective

To analyze the clinical characteristics of stoma site incisional hernia(SSIH) after stoma reduction surgery, in order to enhance clinicians' knowledge and attention to SSIH.

Methods

The clinical data of 232 cases of colorectal surgery+prophylactic enterostomy admitted to the Department of Gastrointestinal Surgery of Sichuan Provincial People's Hospital, School of Medicine(Affiliated Hospital of University of Electronic Science and Technology) were retrospectively analyzed from January 2021 to May 2023.SSIH was confirmed by follow-up and imaging results, and the clinical characteristics related to the incision site of SSIH were analyzed.

Results

A total of 30 (12.9%) of the 232 patients developed SSIH.The comparison of the clinical characteristics of the patients with different outcomes showed that compared with the patients without SSIH, the complicated parastomal hernia,postoperative incisional infections, the diameter of the stoma >2.5 cm, whether the muscle was detached during the reduction, and the technique of suture closure in the patients with SSIH had statistically significant differences (P<0.05).The complicated parastomal hernia, incisional infection after reduction, stoma diameter >2.5 cm, interrupted suture, and detached muscle were independent risk factors for SSIH after prophylactic stoma reduction (Odds Ratio=10.31, 15.17, 5.348, 8.203, 4.671; 95% confidence interval=2.680-45.210, 4.716-57.180, 1.751-18.380, 2.338-37.880, 1.427-18.910).

Conclusion

Measures such as avoiding excessively large prophylactic ostomy, preventing parastomal hernia, avoiding incisional infection during reduction, reducing muscle detachment during ostomy reduction, and using continuous suture during incision closure can help reduce the incidence of SSIH.

表1 预防性造口患者发生SSIH 的临床特征
图1 受试者操作特征曲线分析
表2 影响预防性造口还纳术后造口部位切口疝发生的多因素分析结果
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