开放式肠造口旁疝手术修补法30例分析

目的 分析开放式肠造口旁疝的手术修补方法存在的问题。方法 对2002年6月至2006年6月30例肠造口旁疝病人的手术方式、术后并发症、住院时间、复发情况进行回顾分析。结果 原位腹腔内无张力造口旁疝修补术和移位造口旁疝修补术各有1例复发。移位造口旁疝修补术后有1例皮下积液。原位腹膜前无张力造口旁疝修补术有2例伤口愈合不良。未发生肠坏死及肠梗阻等术后并发症。原位腹腔内和腹膜前无张力造口旁疝修补术后住院时间10～14d，移位造口旁疝修补术后住院时间18～21d。结论 肠造口旁疝无张力修补术的方法还有待进一步改进。     

人工材料在嵌顿及绞窄性造口旁疝修补术的应用

目的探讨嵌顿、绞窄性造口旁疝开放式人工材料修补术的合理性与评价。方法回顾性分析我院2006年3月至2007年9月采用一期人工材料修补治疗嵌顿、绞窄性造口旁疝6例的临床资料。结果全组患者无死亡及腹腔感染。腹膜前用聚丙稀补片修补1例，发生切口感染，20d后取出补片，行原位腹腔内无张力造口旁疝修补术治愈。1例发生切口脂肪液化，经短时间换药治愈。无其他术后并发症。手术时间120—160min，平均130rain；住院时间12—35d，平均17d；术后随访时间3—21个月，平均为11个月，未见早期复发。结论选择性应用人工材料疝修补治疗嵌顿、绞窄性造口旁疝是安全可行的。     

腹腔镜下造口旁疝修补术

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月至2006年4月对6例造口旁疝进行腹腔镜补片疝修补术.结果 6例均在腹腔镜下行腹腔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65～130 min,平均90 min .术后住院6～9 d,平均7 d.术后疼痛达3个月以上者有2例;浆液肿2,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,值得临床推广应用.     

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.     

应用GORE-TEX Dual Mesh行开放式造口旁疝修补术

目的评估应用GORE-TEX Dual Mesh行开放式造口旁疝修补的方法、安全性及临床效果。方法回顾性分析2003年1月至2008年1月在我科应用GORE-TEX Dual Mesh行开放式造口旁疝修补的50例患者的手术情况、术后并发症、住院时间和复发情况。结果50例患者顺利完成开腹造口旁疝修补术,平均手术时间80（60～100）min,平均术后住院7（5～9）d。发生伤口脂肪液化2例,浆液肿1例,经穿刺和理疗后治愈。无肠瘘、尿漏等并发症发生。随访12～48个月,无造口旁疝复发。结论使用GORE-TEX Dual Mesh行开放式造口旁疝修补是一种安全、有效的手术方法。     

肠造口旁疝的手术治疗(附7例报告)

肠造口旁疝是指与肠造口有关的疝，是肠造口术后最常见的晚期并发症，其发生率占所有造口病人的10％-25％．且肠造口旁疝修补术后的复发率在50％左右，因此肠造口旁疝是疝和腹壁外科治疗的难题。本文回顾分析我院疝和腹壁外科治疗和培训中心2001年1月至2004年12月入院手术治疗的7例肠造口旁疝病人的手术方式、术后并发症、住院时间、复发情况等，供大家探讨。     

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。     

腹腔镜造口旁疝修补术的术式选择与并发症处理

目的探讨腹腔镜造口旁疝修补术的术式选择,分析并发症的产生原因,并总结常见并发症的预防和处理方法。方法回顾性分析2014年1月至2016年6月期间于中国医科大学附属盛京医院行造口旁疝修补术的25例病人的临床资料。结果 25例手术中腹腔镜辅助下Keyhole术9例、Modified Sugarbaker术10例、Sandwich术1例、lap-re-do术7例(包括复发病例行多次手术治疗),均获成功。手术时间为63~268 min,平均手术时间为(135.84±56.70)min;术后住院时间为7~33 d,平均术后住院时间为(12.96±7.31)d。术后随访9~39个月,3例复发,1例感染,1例复发再次手术后感染,无肠瘘、慢性疼痛等其他并发症的发生。结论造口旁疝修补术的术式选择和并发症处理要根据病人具体情况而定。     

腹腔镜Sugarbaker七步法修补术在复发性造口旁疝的应用

目的探讨腹腔镜Sugarbaker七步法修补术在复发性造口旁疝中的应用价值。 方法收集2017年1月至2021年5月在中山大学附属第六医院行复发性造口旁疝修补术患者的临床资料和手术录像。评价复发性造口旁疝行腹腔镜Sugarbaker七步法修补的可行性，观察术后复发情况，并结合手术录像复盘分析造口旁疝的复发类型、术中和术后并发症以及术后恢复情况等。 结果共纳入11例复发性乙状结肠造口旁疝病例，均为Sugarbaker术后复发。其中男3例（27.27%），女8例（72.73%），年龄69（66~76）岁，体质指数27.11（24.80~27.55）kg/m²，病程12（4~24）个月。缺损长轴65.99（57.99~88.71）mm，缺损短轴60.96（49.82~87.00）mm。11例患者均顺利完成腹腔镜Sugarbaker七步法修补术，其中腹腔粘连分离时间30（5.50~35.50）min，缺损关闭时间32（25~46）min，总手术时间201（175~251）min，术中出血量20（10~50）ml。通过手术录像复盘，根据补片是否移位，可将造口旁疝复发类型分为补片移位型（9例，81.82%）和非补片移位型（2例，18.18%）。在补片移位型中，根据补片下缘移位的程度分为部分移位型（6例，66.67%）和完全移位型（3例，33.33%）。术后恢复排气时间2（1~4）d，术后住院时间5（4~7）d，无手术部位感染病例。1例术后出现肺部感染，经对症治疗后好转。中位随访时间34.7（27.53~60.40）个月，无复发病例。 结论复发性造口旁疝再次行手术治疗，腹腔镜Sugarbaker七步法修补术是安全可行的。     

Onlay法原位修补造口旁疝45例

目的 总结采用Onlay法原位修补造口旁疝的方法及疗效.方法 2006年2月至2012年4月应用聚丙烯补片经原中线切口入路采用Onlay法原位修补造口旁疝45例.男24例,女21例;年龄43～ 80岁,平均(49±8)岁.疝病史1～17年,平均(12±3)年.其中复发性造口旁疝6例.疝环直径4～9 cm,平均(5.0±2.0) cm.结果 45例均顺利完成Onlay手术.手术时间96～148 min,平均(109±23) min.术后12h至3d拔除胃管,平均(2.0±2.0)d;术后4～9d拔除引流管,平均(6.0±2.0)d.术后住院时间9 ～16d,平均(11-±3)d.术后42例切口Ⅰ期愈合;发生浆液肿7例,经穿刺并局部加压后消失.术后41例获随访,随访时间8～48个月,平均(38±8)个月.患者无术区慢性疼痛、腹壁异物感、术区局部膨出等并发症发生.4例分别于术后3、4、4.5个月及7个月复发,经保守治疗及再次手术治愈. 结论 应用补片经原切口入路采用Onlay法原位修补造口旁疝是一种简便、安全、有效的方法.     

Acellular dermal matrix (AlloDerm): new material in the repair of stoma site hernias

Parastomal hernias are a common complication after ileostomy or colostomy formation and can lead to complications, such as intestinal obstruction and strangulation. When a parastomal hernia presents, repair of the defect can pose a challenge to the surgeon to choose a repair that both reduces complications and recurrence rates. We present three cases of parastomal hernia repair using acellular dermal matrix (AlloDerm) as reinforcement to the primary hernia repair. We prospectively followed three patients who presented with parastomal hernia after ostomy formation in 2001-2002. The patients underwent repair of the parastomal hernia using primary fascial repair with reinforcement using AlloDerm as an on-lay patch. Two patients were followed for 6 months and 1 year, respectively, and remained hernia-free. One patient presented 8 months later with symptoms of intestinal obstruction that were relieved by nasogastric tube decompression and bowel rest. The patient subsequently returned 3 months later with intestinal obstruction and recurrent parastomal hernia that necessitated an operation for relocation of the stoma and repeat hernia repair. Repair of parastomal hernias using AlloDerm acellular dermal matrix as a substitute for a synthetic graft showed resilience to infection and, more importantly, tolerated exposure in an open wound without having to be removed. Larger studies with longer follow-up are needed to see if this material reduces the incidence of hernia recurrence.     

内置法与外置法开放式人工合成材料修补造口旁疝临床对照研究

目的　评价比较内置法和外置法人工合成材料修补法治疗造口旁疝的效果。 方法　回顾性分析2002年1月至2007年7月首都医科大学附属北京朝阳医院收治的48例造口旁疝病人的临床资料。25例行内置法修补,23例行外置法修补。对两组病人的手术时间、术后住院天数及术后各种并发症的发生情况进行统计学分析。 结果　内置法组手术时间（130.00±28.28）min,术后住院（14.16±5.41）d;外置法组手术时间（143.91±28.88）min,术后住院（17.48±6.37）d。随访6～72个月,内置法组术后没有复发,有2例伤口感染,2例皮下积液,3例出现局部慢性疼痛或异物感;外置法组有5例复发,4例伤口感染,6例皮下积液,9例出现慢性疼痛或异物感。复发与术后慢性疼痛或异物感的发生率,内置法组明显低于外置法组（P<0.05）。 结论　两种人工合成材料修补法在开放式造口旁疝修补术中的应用安全有效,内置法可减少术后复发与局部慢性疼痛或异物感的发生,还可减少术后伤口感染与皮下积液发生的可能。     

Laparoscopic repair of incisional and parastomal hernias after major genitourinary or abdominal surgery

BACKGROUND AND PURPOSE: Abdominal wall or parastomal hernias following major genitourinary or abdominal surgery are a significant surgical problem. Open surgical repair is difficult because of adhesion formation and poor definition of the hernia fascial edges. Laparoscopic intervention has allowed effective correction of these abdominal wall hernias. PATIENTS AND METHODS: From November 1997 to June 2000, 14 male and 3 female patients underwent laparoscopic abdominal wall herniorrhaphy at our institution. Of these, 13 patients received incisional and 4 parastomal hernia repair. All hernia defects were repaired using a measured piece of Gore-Tex DualMesh. A retrospective review of each patient's history and operative characteristics was undertaken. RESULTS: All repairs were successful. No patient required conversion to an open procedure, and there were no intraoperative complications. The average operative time was 4 (range 2.5-6.5) and 4.3 (range 3.75-5.5) hours in the incisional and parastomal group, respectively. The average hospital stay was 4.9 days (range 2-12) for the incisional group and 3.8 (range 3-4) days for the parastomal group. To date, two patients experienced a recurrence of incisional hernias, at 5 and 8 months postoperatively. No recurrences have developed in the parastomal hernia repairs at 2 to 33 months. CONCLUSION: Laparoscopic repair of abdominal wall incisional or parastomal hernias provides an excellent anatomic correction of such defects. Adhesions are lysed under magnified laparoscopic vision, and the true limits of the fascial defects are clearly identified. The DualMesh is easy to work with and has yielded excellent results. A comparison with open repair with respect to perioperative factors and long-term success is currently under way.     

不同手术方式治疗腹壁造口旁疝24例

目的 探讨造口旁疝的病因、修补方法及临床疗效.方法 回顾性分析2006年7月至2010年7月安徽医科大学第二附属医院收治的腹壁造口旁疝64例,手术治疗24例,比较三种手术方式的术后复发率及并发症情况.结果 行Onlay修补术5例,复发1例,复发率20%.行Sublay修补术12例,复发2例,复发率16.66%;出现皮下积液、切口感染3例.行IPOM修补术7例,复发1例,复发率14.28%;出现肠粘连肠梗阻症状1例,出现肠漏1例.三组手术方式相比,IPOM及Sublay修补术造口复发率稍低,但无统计学意义（χ2=0.462,P=1.000）.预防性使用补片病例无一例发生造口旁疝,造口旁疝发生率低于常规手术组（χ2=1.533,P=0.539）.结论 造口旁疝发病率较高,修补术后复发率高,并发症多,至今仍无统一的修补标准.预防性放置补片可有效的降低造口旁疝发生率.     

Laparoscopic repair of parastomal hernias: early results

Background: Open repair of parastomal hernias is associated with high rates of morbidity and recurrence. Laparoscopic repair with mesh has been described, and good results have been reported in small case series with short-term follow-up. The purpose of this study was to review our institutions experience with the laparoscopic repair of parastomal hernias. Methods: Nine patients with symptomatic parastomal hernias (five ileal conduits, two ileostomies, and two sigmoid colostomies) underwent laparoscopic repair with mesh between April 1998 and September 2001. Demographics, operative details, postoperative complications, and hernia recurrences were recorded retroprospectively. Results: All of the patients were men; their average age was 66 years (range, 53–77). A single piece of Gore-Tex Dual Mesh with a slit to accommodate the stoma was used in seven of nine repairs; in the other two patients, two pieces of mesh were used. Concurrent incisional hernias were repaired in three of nine patients (33.3%). The average operating time was 243 min (range, 136–360). The average postoperative length of stay was 4.7 days (range, 2–7). Immediate postoperative complications occurred in three patients (33.3%) (one ileus, one urinary retention, and one ulnar neuropathy). Recurrences developed in four patients (44.4%), and in one patient (11.1%) the stoma prolapsed; all of these failures occurred within 6 months of the operation. One patient died 10 months postoperatively, without evidence of hernia recurrence. Three patients are without evidence of recurrence after 18, 21, and 33 months (average, 24) of follow-up, respectively. Conclusion: In this series, laparoscopic repair of parastomal hernia failed in 56% of patients, all within 6 months of the operation. Although the laparoscopic approach has potential advantages compared to the conventional open methods, the initial results are disappointing. Advances in the technique may improve the early results, and further prospective studies are needed to determine the efficacy of this approach.     

腹腔镜与开放杂交应用Sublay&Onlay-Keyhole术原位修补造口旁疝的疗效

目的探讨腹腔镜与开放杂交应用Sublay&Onlay-Keyhole术原位修补造口旁疝的方法及疗效。 方法2017年5月至2019年5月,解放军总医院第四医学中心采用腹腔镜与开放杂交应用Sublay&Onlay-Keyhole术原位修补造口旁疝11例。患者均为永久性造瘘,其中8例为低位直肠癌行Miles术式后的乙状结肠末端造瘘,3例为膀胱癌行回肠代膀胱术后的回肠末端造瘘。2例患者既往曾行造口旁疝修补术后复发。末次术后3.5~4.0年,平均3.75年。疝环最长径为4~8 cm,平均5.55 cm。 结果11例均以腹腔镜与开放杂交应用Sublay&Onlay-Keyhole术成功完成腹壁重建手术。手术时间110~190 min,平均141.55 min;术后住院时间6~18 d,平均10 d。术后患者切口均Ⅰ期愈合,无肠瘘及腹壁感染发生。2例（18.2%）发生血清肿。随访时间6~23个月,平均随访14.55个月。11例患者术后未见造口旁疝复发或发生其他切口疝。 结论腹腔镜与开放杂交应用Sublay&Onlay-Keyhole术原位修补造口旁疝是腹壁重建的有效方法,具有复发率低、并发症少等优点,但远期疗效仍需进一步观察随访。     

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     

腔镜修复术治疗结肠造口旁疝

目的总结腔镜下补片修补造口旁疝的手术技术要点。方法回顾性分析2004年9月至2006年11月复旦大学附属华山医院外科收治的16例行腔镜修补术治疗结肠造口旁疝病人的临床资料。结果16例造口旁疝病人中,14例修补成功,2例中转为开放缝合修补（1例因腹腔内广泛致密粘连,1例因小肠损伤）。手术时间平均116min（45～180min）。疝环直径平均5.4cm（4～6cm）。术后出现暂时性腹胀4例,修补区域腹壁疼痛12例（最长持续3周后明显缓解）,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）,7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,未发生与手术相关的感染）。术后住院时间平均5.4d（3～8d）。术后随访平均7个月（1～17个月）,未见早期复发,疝囊较小和发病初期就行修补术者外观优于疝囊较大和发病时间较长者。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,效果亦较理想。     

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??Clinical research of two kinds of open operation in herniorrhaphy with artificial synthetic material for parastomal hernias SHEN Ying-mo, CHEN Jie. Center of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital University of Medical Science, Beijing 100020, China Abstract Objective To evaluate the effect of two kinds of open operation in herniorrhaphy with artificial synthetic material for parastomal hernias by the application with the method of IPOM or Onlay respectively. Methods The clinical data of 48 patients with parastomal hernia admitted from January 2002 to July 2007 at Beijing Chaoyang Hospital of Capital University of Medical Science were analyzed retrospectively. Twenty-five patients received Bard CK parastomal patch repair (IPOM group). Twenty-three patients received Bard Marlex mesh repair (Onlay group). Data collected included operation time, days of postoperative stay, the cases of postoperative complications. The data were analyzed by statistical method. Results No significant difference was found between the two groups in the operation time and the days of postoperative stay. During the follow up period of 6??72 months, there was no recurrence but there were 2 cases of wound infection, 2 cases of subcutaneous seroma and 3 cases of postoperative chronic pain or foreign body sensation in the IPOM group. There were 5 cases of recurrence, 4 cases of wound infection, 6 cases of subcutaneous seroma and 9 cases of postoperative chronic pain or foreign body sensation in the Onlay group. The incidence of recurrence and postoperative chronic pain or foreign body sensation in the IPOM group were lower than those in the Onlay group significantly (P<0.05). Conclusion The two kinds of open operation in herniorrhaphy with artificial synthetic material for parastomal hernias are safe and effective surgical procedures. The method of IPOM can diminish the incidence of recurrence and postoperative chronic pain or foreign body sensation, and diminish the incidence of postoperative wound infection and subcutaneous seroma.