腹腔镜下造口旁疝修补要点

造口旁疝是各种腹部造口手术后常见的后期并发症之一,其发病率在术后2年内高达1.8%～48.0%[1],绝大部分造口旁疝病人会出现皮肤刺激、局部钝痛等症状,同时由于疝囊及其内容物不断增大,不仅会影响到造口装置的密封性,甚至可引起肠梗阻、肠坏死等严重并发症,从而大大降低了病人术后的生活质量并威胁到病人的生命安全.     

腹腔镜下行造口旁疝补片修补术

目的:探讨腹腔镜下应用补片行造口旁疝修补术的方法、安全性及临床效果.方法:2004年11月～2006年8月,对10例造口旁疝进行腹腔镜下补片修补术.结果:10例均在腹腔镜下行腹腔内粘连松解和补片固定,顺利完成造口旁疝修补手术.手术时间65～135 min,平均92 min.术后住院6～9 d,平均7 d.术后持续疼痛达3个月以上者3例,术后浆液肿2例,经穿刺抽液和加压包扎后治愈.无手术死亡、无造口感染和肠瘘发生.随访7～26个月(平均13个月),未见造口旁疝复发.结论:腹腔镜下行腹腔内粘连松解、采用腔内缝合器固定补片来修补造口旁疝是一种安全、有效的微创方法,值得推广应用.     

开放式造口旁疝修补术的手术要点

造口旁疝是造口术后常见的晚期并发症,其发病情况与术后时间呈正相关,随着随访时间的延长,其发病率从5%增加至50%,甚至有报道其发病率为100%.大部分病人对造口旁疝耐受性较好,可通过非手术治疗达到缓解症状的目的.25%～30%的病人最终需手术治疗[7].     

腹腔镜乙状结肠造口旁疝修补术7例

造口旁疝是乙状结肠造口术后常见的并发症，常见的开放手术治疗有原位单纯疝修补术、造口重建及网片修补术。我院自2011年11月-2013年2月对7例造口旁疝进行了腹腔镜修补手术[1-2]，现报道如下。     

腹腔镜造口旁疝修补术13例报告

目的探讨采用腹腔镜钥匙孔手术行造口旁疝修补术的可行性。方法回顾性分析2007年11月～2011年10月采用钥匙孔技术及Proceed补片完成的13例腹腔镜造口旁疝修补术的临床资料。2例回肠代膀胱造瘘,11例左下腹永久性乙状结肠造瘘,其中1例为造口旁疝修补术后复发。术中游离疝周粘连后,将补片适当修剪,中间留圆孔,置于疝囊下方,用5mm螺旋钉枪固定于腹壁。结果所有患者均顺利完成手术。术中并发症2例：横结肠系膜血管损伤1例,造瘘肠管损伤1例;术后并发症3例：切口感染1例,血清肿2例。术后随访5-52个月,平均26个月,1例复发,1例死于肺部感染。结论采用腹腔镜钥匙孔手术及Proceed补片行腹腔镜造口旁疝修补术是安全可行的,临床疗效较为满意,在降低造口旁疝修补术后补片相关并发症发生率和复发率方面具有一定的意义。     

腹腔镜修补造口旁疝术式选择和技术要点

全腹腔镜造口旁疝修补术治疗结肠造口旁疝术后复发率高;腹腔镜Sugarbaker修补术治疗回肠造口旁疝效果较好;腹腔镜Lap-re-Do修补术较全腹腔镜造口旁疝修补术修补效果更好。对于疝囊较小、较早期的结肠造口旁疝、回肠造口旁疝及回肠代膀胱的造口旁疝,全腹腔镜造口旁疝Sugarbaker法修补术可作为选择术式之一;而对于更多的结肠造口旁疝,腹腔镜Lap-re-Do修补术可能是更好的选择。     

Miles术后造口旁疝腹腔镜下补片修补术的临床应用

<正>Miles术是治疗中低位直肠癌和肛管癌的标准术式,但术后发生造口旁疝会严重影响病人的生活质量。Miles术后造口旁疝的发生率早期约为1%,晚期则高达10%～50%[1],严     

腹腔镜下造口旁疝补片修补术应用体会

目的探讨腹腔镜下造口旁疝修补术的临床效果。方法回顾性分析2007年9月至2010年4月期间8例行腹腔镜下造瘘口旁疝补片修补术患者的临床资料,分析手术情况、术后并发症及复发情况。结果 8例造口旁疝患者均在腹腔镜下修补成功。手术时间50～180min,平均135min。疝环大小4.5～6.5cm,平均5.0cm。术后1例出现肠梗阻及复发,后行腹腔镜探查及再次修补术。2例术后早期出现腹胀,1周后腹胀缓解。1例术后出现术区疼痛不适,对症治疗后缓解。本组未发生术区感染。住院时间5～14d,平均7.6d。术后随访1年,除1例复发后行再次手术外,均未见复发。结论腹腔镜下造口旁疝修补术如果注意操作要点,可以替代传统修补术。     

经同侧腹直肌易位造口在腹腔镜造口旁疝修补术中的应用

目的分析经同侧腹直肌易位造口在腹腔镜造口旁疝修补术中的应用价值。 方法选取2016年8月至2017年12月,重庆市开州区中医院收治的60例乙状结肠造口旁疝患者,随机分为对照组和观察组,每组30例。对照组行开放造口旁疝修补术,观察组行腹腔镜经同侧腹直肌易位造口修补术。比较2组患者手术和住院情况、并发症发生率、复发率、远期疼痛发生率及切口疝发生率。 结果观察组患者感染发生率、并发症总发生率及复发率分别为0、16.67%及3.33%,明显低于对照组16.67%、43.33%及23.33%,差异有统计学意义（χ²=5.455、5.079、5.192,P=0.020、0.024、0.023）。观察组患者手术时间、住院费用分别为（131.05±12.11）min、（38 946.06±1 019.75）元均高于对照组（96.91±10.54）min、（18 492.19±572.36）元,差异有统计学意义（t=11.647、95.802,P均<0.001）。观察组患者术中出血量、术后下床活动时间及术后恢复活动时间分别为（33.14±8.06）ml、（1.26±0.51）d、（3.59±1.17）d均低于对照组（69.28±9.18）ml、（2.27±1.02）d、（5.44±2.25）d,差异有统计学意义（t=16.204、4.851、3.996,P均<0.001）。 结论经同侧腹直肌易位造口在腹腔镜造口旁疝修补术中应用效果较好,能够有效改善乙状结肠造口旁疝患者手术情况及住院情况,减少术后并发症的发生和疝复发。     

Laparoscopic parastomal hernia repair

Historically, parastomal hernias have represented a challenge to surgeons. Unsatisfying results from surgical repair have led to many modifications over time. Surgical repair of parastomal hernias has evolved from the traditional open technique to the current laparoscopic approach. We outline a technique that combines mesh reinforcement with a minimally invasive approach.     

Laparoscopic parastomal hernia repair

Parastomal hernia is a common complication of ostomy construction. The morbidity and recurrence rates associated with repair can be quite high. Among the various approaches to repair, the lowest recurrence rates are associated with the use of mesh. We report a case in which a parastomal hernia was repaired laparoscopically. By employing this minimally invasive approach, our patient avoided the morbidity associated with laparotomy for intraperitoneal mesh placement.     

Laparoscopic parastomal hernia repair

Background Management of the parastomal hernia represents a common clinical dilemma for both the surgeon and patient. Once established, these defects are notoriously difficult to treat. Although most parastomal hernias can be managed nonoperatively, approximately 30% will require intervention secondary to complications such as obstruction, pain, bleeding, poorly fitting appliances, or leakage. Overall complication rates of up to 88%, combined with a growing body of literature citing decreased patient morbidity and improved outcomes with laparoscopic tension-free mesh repair of ventral hernias, have led many surgeons to apply these techniques to this difficult problem. Methods This was a retrospective review of 21 consecutive patients who underwent laparoscopic repair of their parastomal hernias with ePTFE mesh. Results Nine (43%) were ileal conduits, seven (33%) were ileostomies, and five (24%) were colostomies. Eight patients had undergone prior hernia repair. Follow-up ranges from 1 to 36 months (average 14 months). There has been one recurrence (5%). Other complications included laparoscopic re-operation for obstruction of a urinary conduit (n = 1), mesh removal for infection (n = 2), Clostridium Difficile colitis (n = 1), pneumonia (n = 2), renal failure (n = 1), surgical site infection (n = 1), and bowel obstruction at a site remote from the hernia repair (n = 2). Conclusion The laparoscopic approach to parastomal hernias is a new technique that offers many potential advantages over conventional open repairs. Based on our initial experience, this repair seems to be associated with a low recurrence rate. Poster presentation at Society of American Gastrointestinal Endoscopic Surgeons, April 18–22, Las Vegas, Nevada, USA.     

Laparoscopic parastomal hernia repair

Repair of parastomal represents a significant challenge for the hernia surgeon. Repair of these hernias is indicated because of an ill-fitting appliance, cosmetic deformity, inability to maintain proper hygiene and complications from the hernia itself such as incarceration or strangulation. Recent reports in the literature have shown that primary fascial repair can occur in 46% of patients and relocation of the stoma is associated with a 40% recurrence rate. For this reason, the use of polypropylene mesh has been applied to this repair. The recurrence rate with this open technique will still incur a failure rate of 20–29%. Additionally there are other complications such as obstruction, fistulization or mesh erosion with this biomaterial. The laparoscopic approach to this hernia may offer a new choice for this difficult problem. We have used ePTFE to repair 12 parastomal hernias with three different approaches. There have been eight colostomy, two ileostomy and two urostomy hernias. Follow-up ranges from 3–39 months (average 20 months). There has been one recurrence that required two repairs (8%). Other complications included enterotomy (one patient), ileus (one), seroma (one), and death from postoperative aspiration (one). The laparoscopic repair of parastomal hernias appears to be a promising technique for this complex dilemma.Presented at the meeting of the American Hernia Society, Orlando, FL, February 2004     

造口旁疝的腹腔镜手术

手术是治愈腹壁疝的唯一方法,但外科医生对造口旁疝的手术治疗却较为棘手。近年来,腹腔镜技术及补片被广泛应用于造口旁疝的治疗中．取得了一些进步．但依然存在复发及造口功能和外观不佳等问题．因此．对造口旁疝的手术不仅要运用无张力疝修补手术的方式来修补缺损,而且还要需要对造口进行重建。     

腹腔镜造口旁疝补片修补术的临床体会

目的:探讨腹腔镜造口旁疝补片修补术的手术方法和临床效果.方法:回顾分析2008年6月至2010年10月为38例患者施行腹腔镜造口旁疝补片修补术的临床资料.结果:35例顺利完成腹腔镜手术,3例中转开腹,其中2例腹腔内广泛致密粘连,1例肠管损伤.手术时间60～125 min,平均90 min;疝环直径4～9 cm,平均6 ...     

Laparoscopic parastomal hernia repair using a nonslit mesh technique

Background The management of parastomal hernia is associated with high morbidity and recurrence rates (20–70%). This study investigated a novel laparoscopic approach and evaluated its outcomes. Methods A consecutive multi-institutional series of patients undergoing parastomal hernia repair between 2001 and 2005 were analyzed retrospectively. Laparoscopy was used with modification of the open Sugarbaker technique. A nonslit expanded polytetrafluoroethylene (ePTFE) mesh was placed to provide 5-cm overlay coverage of the stoma and defect. Transfascial sutures secured the mesh, allowing the stoma to exit from the lateral edge. Five advanced laparoscopic surgeons performed all the procedures. The primary outcome measure was hernia recurrence. Results A total of 25 patients with a mean age of 60 years and a body mass index of 29 kg/m² underwent surgery. Six of these patients had undergone previous mesh stoma revisions. The mean size of the hernia defect was 64 cm², and the mean size of the mesh was 365 cm². There were no conversions to open surgery. The overall postoperative morbidity was 23%, and the mean hospital length of stay was 3.3 days. One patient died of pulmonary complications; one patient had a trocar-site infection; and one patient had a mesh infection requiring mesh removal. During a median follow-up period of 19 months (range, 2–38 months), 4% (1/25) of the patients experienced recurrence. Conclusion On the basis of this large case series, the laparoscopic nonslit mesh technique for the repair of parastomal hernias seems to be a promising approach for the reduction of hernia recurrence in experienced hands. Presented at the Plenary Session of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2006 Annual Meeting, Dallas, Texas, April 2006     

腹腔镜下造口旁疝补片修补术

目的探讨腹腔镜下造口旁疝补片修补术的效果。方法2004年9月-2005年12月，对7例造口旁疝进行腹腔镜补片修补术。结果6例修补成功，1例因腹腔内广泛致密粘连而中转为剖腹缝合修补。手术时间45-180min，平均109min。疝环直径4-6cm，平均5．6cm。术后暂时性腹胀2例；5例修补区域腹壁疼痛，3周内明显缓解；4例血清肿，经2-4次穿刺抽液并加压包扎后治愈。无血肿发生，未发生与手术相关的感染。术后住院时间3-8d，平均5．1d；术后随访2-15个月，平均8．3月，未见复发。结论腹腔镜造口旁疝补片修补术技术上安全、可行，早期的临床疗效较理想。