造口旁疝诊疗进展

doi:10.3877/cma.j.issn.1674-392X.2026.02.018

造口旁疝是腹壁造口术后最常见的远期并发症之一。其发病率因缺乏统一分类标准、诊断方法及随访时间差异而差异较大。造口旁疝的发生受多因素影响，包括患者因素、手术方式及腹壁结构改变等。影像学检查中以CT为首选诊断方法，但超声和MRI检查在特定情况下亦具价值。手术治疗策略多样，不同术式的复发率、并发症及长期疗效存在差异。近年来，预防性补片植入在降低造口旁疝发生率方面显示出一定优势。未来仍需通过高质量前瞻性研究进一步明确诊疗规范及优化个体化治疗策略。本文对近年来造口旁疝诊断与治疗相关研究进展进行综述。

关键词: 造口旁疝, 腹壁疝, 补片修补, 腹腔镜, 个体化

Parastomal hernia is one of the most common long-term complications following stoma creation. The reported incidence varies widely due to the lack of standardized classification systems, diagnostic criteria, and variations in follow-up duration. The occurrence of parastomal hernia is influenced by multiple factors, including patient-related factors, surgical techniques, and alterations in abdominal wall structure. CT is the preferred diagnostic method in imaging examinations, but ultrasound and MRI are also valuable in specific scenarios. Various surgical approaches are available, with differences in recurrence rates, complication profiles, and long-term outcomes among procedures. In recent years, preventive mesh placement has shown certain advantages in reducing the incidence of paraostomaly hernia. In the future, high-quality prospective research is needed to further establish standardized diagnostic and treatment criteria and optimize individualized treatment strategies. This article provides a review of recent advances in the diagnosis and treatment of parastomal hernia.

Key words: Parastomal hernia, Abdominal hernia, Mesh repair, Laparoscopy, Individualization

表1 六种造口旁疝分型方法

分型方法	分型依据	具体分型							主要特点	临床意义
分型方法	分型依据	0	Ⅰ		Ⅱ	Ⅲ		Ⅳ	主要特点	临床意义
Devlin分型^[9]	术中发现	-	腹壁间位疝		皮下疝	造口内疝		造口旁疝	依赖临床触诊，侧重疝突出程度	简单易用，但受主观影响大，指导手术有限
Rubin分型^[10]	术中发现+造口脱垂	-	真性造口旁疝	Ⅰa:腹壁间 Ⅰb:皮下	腹壁间位疝	皮下脱垂		假疝(腹壁膨出)	纳入造口脱垂情况	对造口脱垂患者手术方式有一定指导
Moreno-Matias分型^[11]	CT影像	伴随肠壁的腹膜构成造口，未形成疝囊	Ⅰa：结肠造口形成疝囊<5 cm		大网膜疝入疝囊	伴有造口肠管以外的肠袢		-	基于影像学，客观	提供术前评估依据，便于研究
Moreno-Matias分型^[11]	CT影像	伴随肠壁的腹膜构成造口，未形成疝囊	Ⅰb：结肠造口形成疝囊>5 cm		大网膜疝入疝囊	伴有造口肠管以外的肠袢		-	基于影像学，客观	提供术前评估依据，便于研究
Gil & Szczepkowski分型^[12]	体格检查+合并切口疝	-	孤立小的造口旁疝		小造口旁疝合并中线切口疝	孤立的大造口旁疝		较大的造口旁疝伴中线切口疝	可识别复杂病例	指导复杂病例识别，但对手术选择有限
EHS分型^[13]	缺损大小+合并切口疝	-	小造口旁疝(疝环≤5 cm)，无切口疝		小造口旁疝(疝环≤5 cm)合并切口疝	大造口旁疝(疝环>5 cm)无切口疝		大造口旁疝(疝环>5 cm)合并切口疝	简单易掌握，区分初发与复发	广泛认可，指导临床诊疗与研究设计
EHS分型^[13]	初发(P) 复发(R)	-	小造口旁疝(疝环≤5 cm)，无切口疝		小造口旁疝(疝环≤5 cm)合并切口疝	大造口旁疝(疝环>5 cm)无切口疝		大造口旁疝(疝环>5 cm)合并切口疝	简单易掌握，区分初发与复发	广泛认可，指导临床诊疗与研究设计
改良Rubin分型^[14]	Rubin分型基础上改良	-	真性造口旁疝		腹壁间位疝	造口脱垂	Ⅲa:外脱垂 Ⅲb:内脱垂	假疝(腹壁膨出)	兼顾造口脱垂和疝缺损，便于临床应用	在保留EHS优势基础上，更有助于术式选择及队列研究

表1 六种造口旁疝分型方法

分型方法	分型依据	具体分型							主要特点	临床意义
分型方法	分型依据	0	Ⅰ		Ⅱ	Ⅲ		Ⅳ	主要特点	临床意义
Devlin分型^[9]	术中发现	-	腹壁间位疝		皮下疝	造口内疝		造口旁疝	依赖临床触诊，侧重疝突出程度	简单易用，但受主观影响大，指导手术有限
Rubin分型^[10]	术中发现+造口脱垂	-	真性造口旁疝	Ⅰa:腹壁间 Ⅰb:皮下	腹壁间位疝	皮下脱垂		假疝(腹壁膨出)	纳入造口脱垂情况	对造口脱垂患者手术方式有一定指导
Moreno-Matias分型^[11]	CT影像	伴随肠壁的腹膜构成造口，未形成疝囊	Ⅰa：结肠造口形成疝囊<5 cm		大网膜疝入疝囊	伴有造口肠管以外的肠袢		-	基于影像学，客观	提供术前评估依据，便于研究
Moreno-Matias分型^[11]	CT影像	伴随肠壁的腹膜构成造口，未形成疝囊	Ⅰb：结肠造口形成疝囊>5 cm		大网膜疝入疝囊	伴有造口肠管以外的肠袢		-	基于影像学，客观	提供术前评估依据，便于研究
Gil & Szczepkowski分型^[12]	体格检查+合并切口疝	-	孤立小的造口旁疝		小造口旁疝合并中线切口疝	孤立的大造口旁疝		较大的造口旁疝伴中线切口疝	可识别复杂病例	指导复杂病例识别，但对手术选择有限
EHS分型^[13]	缺损大小+合并切口疝	-	小造口旁疝(疝环≤5 cm)，无切口疝		小造口旁疝(疝环≤5 cm)合并切口疝	大造口旁疝(疝环>5 cm)无切口疝		大造口旁疝(疝环>5 cm)合并切口疝	简单易掌握，区分初发与复发	广泛认可，指导临床诊疗与研究设计
EHS分型^[13]	初发(P) 复发(R)	-	小造口旁疝(疝环≤5 cm)，无切口疝		小造口旁疝(疝环≤5 cm)合并切口疝	大造口旁疝(疝环>5 cm)无切口疝		大造口旁疝(疝环>5 cm)合并切口疝	简单易掌握，区分初发与复发	广泛认可，指导临床诊疗与研究设计
改良Rubin分型^[14]	Rubin分型基础上改良	-	真性造口旁疝		腹壁间位疝	造口脱垂	Ⅲa:外脱垂 Ⅲb:内脱垂	假疝(腹壁膨出)	兼顾造口脱垂和疝缺损，便于临床应用	在保留EHS优势基础上，更有助于术式选择及队列研究

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Progress in diagnosis and treatment of parastomal hernia

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Progress in diagnosis and treatment of parastomal hernia