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。     

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.     

造口旁疝治疗进展-腹腔镜造口旁疝修补术

1 造口(旁)疝定义 从造口组织(旁)腹壁缺损处突出的疝. 2 造口(造瘘)目的 造口:人为的将肠管或尿道在腹壁上造一瘘口,用于废物排出体外.(1)永久性造口:单腔造口多是永久性的,如结肠造瘘(人工肛门);(2)暂时性造口:双腔造口常是暂时性的,如回肠造瘘、结肠造瘘.     

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 ...     

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。     

腹腔镜造口旁疝修补术

造口旁疝是指病人接受造口手术后，由于各种因素导致腹腔内组织和器官突出于结肠、空肠或尿道等造口周围的人造通道中所形成的肿物。是各种造口手术常见的术后并发症之一，发生率约为造口手术的10％-25％．在Miles和Hartmann手术中发病率更是高达30％～50%。术后一旦发生造口旁疝往往会由于缺乏有效的治疗措施以及病人自身的疏忽，使得疝囊及其内容物不断增大。从而直接影响到造口装置的密封性；同时绝大部分病人都会出现皮肤刺激、局部胀痛及消化不良等不适症状，降低了病人术后的生活质量。     

造口旁疝的外科治疗与术式选择

造口旁疝是腹部各类造口术后的常见并发症之一,造口旁疝的发病率随着时间的推移而增加。随着病情发展,造口旁疝会给患者造成不适,甚至给患者带来生命威胁。本文就造口旁疝的诊断、分型、预防及常用术式的比较和选择进行总结和论述。     

腹腔镜下造口旁疝补片修补术可行性、安全性探讨

目的：就所开展的腹腔镜下造口旁疝补片修补术的临床资料，进行该手术可行性和安全性的探讨。方法：自2004年9月至2006年4月，我院为10例造口旁疝病人进行了腹腔镜下补片修补术。结果：10例造口旁疝病人中9例修补成功，1例因腹腔内广泛致密粘连而中转为开腹缝合修补；手术时间平均113（45～180）min：疝环大小平均5．6（4～6）cm；术后2例出现暂时性腹胀；7例修补区域腹壁疼痛，持续2周后均明显缓解：1例出现呼吸功能减退，经使用无创呼吸机辅助治疗后缓解；5例出现浆液肿，经2～4次穿刺抽液并加压包扎后治愈，无血肿发生．也未发生与手术相关的感染。术后住院时间平均5．7（3-9）d；术后随访平均9．1（2～19）个月，未见早期复发。结论：腹腔镜造口旁疝补片修补术从技术上讲是安全、可行的，从早期的临床结果来看．效果较理想。     

Prevention of parastomal hernia using preperitoneal mesh: a prospective observational study

OBJECTIVE: Parastomal hernia is a common complication after stoma formation. The objective of the study was to see whether placing prophylactic preperitoneal mesh could reduce the incidence of parastomal hernia. METHOD: Patients having elective bowel surgery requiring permanent stoma were included in this study. The time required for mesh insertion, day of stoma function, and early complications were recorded. Follow up was at 6 weeks, 3-monthly for the first year and at 6-monthly intervals thereafter. RESULTS: Eighteen patients fulfilled the inclusion criteria and were followed up for 6-28 months (mean 16.05). The time taken for mesh placement was 12-22 min (mean 14). One patient had to have revision surgery on day 1 for stomal necrosis - the mesh was left in situ in that instance. This patient developed superficial laparotomy wound infection. During the follow up, no patients developed parastomal hernia, stomal prolapse, stenosis, retraction, fistula or obstruction. CONCLUSION: The early results, in this group of patients, show that prophylactic polypropylene mesh insertion at the time of permanent stoma formation is encouraging and long-term results are awaited.     

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。     

造口旁疝修补材料选择及应用

修补材料在造口旁疝手术治疗中发挥重要作用,如何正确选择并合理应用补片是造口旁疝修补手术的关键问题之一。补片的材料学参数指标包括强度和弹性、补片的重量和网孔大小、补片的皱缩率和组织相容性等方面。补片按材料学分类包括聚丙烯、聚酯等合成补片,具有防粘连性能的复合补片以及生物补片。在补片的选择和应用中须关注补片的强度和有效性,也应注意应用补片的安全性及合理性。     

Modified technique for parastomal hernia repair in patients with intractable stoma-care problems

OBJECTIVE: Although stoma relocation is generally the first choice of treatment for parastomal hernia, a repair using polypropylene prosthetic mesh is sometimes employed in cases of parastomal hernia recurrence. Use of this mesh, however, has been associated with a high risk of bowel erosion, adhesions formation, and fistulization. We therefore began to use expanded polytetrafluoroethylene (ePTFE) mesh to perform an onlay parastomal hernia repair. Our initial clinical experience with this procedure is described. PATIENTS AND METHODS: Sixteen patients aged 39-70 years with intractable stoma problems underwent a modified intra-abdominal onlay technique with implantation of a large (26 x 36 cm) sheet of ePTFE mesh. RESULTS: During a median follow-up of 29 months (range, 5-52 months), no mesh-related bowel erosion, fistulization, or adhesion formation were observed. Two patients had a recurrence of the hernia due to technical failure. Re-operation in one of these resulted in wound dehiscence and removal of the contaminated mesh. Another patient developed intestinal obstruction postoperatively. The mesh was removed, and a gastrointestinal stromal tumour was found. Finally, a nonmesh related small bowel erosion required removal of the mesh in one patient. All other patients had full relief of symptoms. CONCLUSION: The modified onlay technique using a large sheet of ePTFE prosthetic mesh is a feasible option for treatment of parastomal hernia recurrence. Possible advantages of the procedure include stoma preservation, strengthening of the abdominal wall, and a reduced risk of recurrence, contamination, fistulization, and bowel adhesions and erosion.     

Laparoscopic parastomal hernia repair is feasible and safe: early results of a prospective clinical study including 55 consecutive patients

Background Parastomal herniation is a common complication, and its operative treatment is notoriously difficult. Recently, the authors have described a laparoscopic technique for closure and reinforcement of the hernia with a hand-made “funnel-shaped” Gore-Tex Dual Mesh. Potentially this technique combines the advantages of a mesh repair with those of minimal invasive surgery. Methods In 2002, a multicenter trial of this new technique was started in The Netherlands. To date, 55 consecutive patients (27 men; median age, 63 years) with a symptomatic primary (n = 45) or recurrent (n = 10) parastomal hernia have undergone elective surgery using this technique. The demographic, perioperative, and early follow-up data prospectively collected for these patients are presented in this report. Results Of the 55 procedures, 47 (85.5%) could be completed laparoscopically (median operation time, 120 min). Conversion to laparotomy was indicated because of dense adhesions prohibiting safe dissection (n = 4) or bowel injury (n = 4). No in-hospital mortality occurred. Postoperative recovery was uneventful for 47 patients (85%), who had a median hospital stay of 4 days. Surgical and nonsurgical complications occurred, respectively, for four patients each (7.2%). Full-thickness enterotomy appeared to be the most troublesome complication. After 6 weeks, when all the patients were reexamined, one recurrence was noted. Conclusion Maximal efforts should be undertaken to prevent perioperative full-thickness enterotomy. Because this was achieved for the vast majority of patients, it is concluded that laparoscopic parastomal hernia repair is feasible and safe. Although a longer follow-up period is needed for definitive conclusions to be drawn regarding the recurrence rate, early follow-up evaluation shows very promising results. Presented at the 10th World Congress of Endoscopic Surgery, Berlin, Germany on 13–16 September 2006     

Repair of ileal conduit parastomal hernia by translocation of the stoma

We repaired a recurrent ileal conduit parastomal hernia, according to Kaufman's technique, by translocating the stoma to the opposite side of the abdominal wall without laparotomy. This procedure is a simple and less invasive treatment for large parastomal hernia.     

腹腔镜造口旁疝补片Sugarbaker修补术后2次复发1例报告

造口旁疝是结肠造口术后常见的并发症,手术是惟一治愈手段,但术后有一定的复发率.笔者收治经过3次修补的造口旁疝1例.报告如下. 1 病历简介 病人女性,64 岁.身高155 cm,体重66 kg,BMI 27.47.于2016-07-08 因"直肠癌Mile's术后1年半,造口旁肿物膨出半年"就诊笔者医院.入院后诊断为造...