中国实用外科杂志

中国实用外科杂志 ›› 2022, Vol. 42 ›› Issue (07): 777-781.DOI: 10.19538/j.cjps.issn1005-2208.2022.07.15

• 论著 • 上一篇    下一篇

疝囊镜技术用于腹腔镜造口旁疝修补术价值分析

王    瑶，李    原，刘力嘉，陈思梦   

  1. 南京医科大学第一附属医院普外科，江苏南京 210029
  • 出版日期:2022-07-01 发布日期:2022-07-05

  • Online:2022-07-01 Published:2022-07-05

摘要： 目的    探讨疝囊镜技术在腹腔镜造口旁疝修补术中的应用价值。方法    回顾性分析2019年7月至2021年12月南京医科大学第一附属医院普外科疝专业组收治的61例造口旁疝病人的临床资料，其中全腹腔镜疝修补术37例（腹腔镜组），腹腔镜手术中转开放手术24例（中转组）。两组中共有16例术中应用疝囊镜技术。比较不同手术病人术后相关指标的差异，分析疝囊镜技术对腹腔镜造口旁疝修补中转开放手术的影响。结果    58例行腹腔内补片疝修补术，包括Sugarbaker手术52例，Keyhole手术5例，Sandwich手术1例；3例缝合修补术。腹腔镜组共37例，含应用疝囊镜技术避免中转开放的10例；中转组共24例，包括应用疝囊镜技术后仍中转开放手术的6例，中转手术中造口重建占比为66.7%。应用疝囊镜技术使腹腔镜手术成功率由44.3%增高至60.7%。腹腔镜组和中转组相比，病程、缺损面积、血红蛋白、白蛋白、合并症（糖尿病等）差异无统计学意义（P>0.05），比较手术时间［（136.3±32.5）min vs. （205.6±62.8）min］、术后住院时间［7.0（6.0，10.0）d vs. 10.5（7.3，15.3）d］、切口感染（0 vs. 6例）、造口并发症（0 vs. 7例）差异有统计学意义（P<0.05）。腹腔镜手术中使用疝囊镜技术的病人（16例）与直接中转开放手术者（18例）相比，以上各项指标差异均无统计学意义（P>0.05）。结论    腹腔镜造口旁疝手术中应用疝囊镜技术有助于降低中转开放手术比例，手术安全易行，是腹腔镜造口旁疝修补术中一种很好的补充技术。

关键词: 造口旁疝, 手术, 腹腔镜, 疝囊镜, 中转

Abstract: Application of hernioscopic technique in laparoscopic parastomal hernia repair        Wang Yao，Li Yuan，Liu Li-jia，et al. Department of General Surgery，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，China
Corresponding author：CHEN Si-meng，E-mail：chen_simeng@yeah.net
Abstract    Objective    To explore the application value of hernioscopic technique in laparoscopic parastomal hernia repair. Methods    The clinical data of 61 patients who underwent laparoscopic parastomal hernia repair in the Hernia Surgery of the First Affiliated Hospital of Nanjing Medical University from July 2019 to December 2021 were analyzed retrospectively. According to the operation method, it can be divided into total laparoscopic operation group and conversion to open operation group. A total of 16 cases in the two groups were treated with hernioscopic surgery. To analyze the effect of hernioscopy on the conversion of laparoscopic parastomal hernia repair. Results    58 cases underwent IPOM repair with patch，including Sugarbaker operation in 52 cases，Keyhole operation in 5 cases and Sandwich operation in 1 case; 3 cases underwent suture repair. There were 37 cases in the total laparoscopic surgery group，of which 10 cases avoided conversion to open surgery by hernioscopic technique; There were 24 cases of conversion to open surgery group, and 6 cases were still converted to open operation after hernioscopy. The proportion of stoma reconstruction in the conversion group was 66.7%. The success rate of laparoscopic surgery increased from 44.3% to 60.7% by hernioscopy. There was no significant difference in the course of the disease , defect size, hemoglobin, albumin, complications (diabetes, etc) between the laparoscopic surgery group and conversion surgery group（P>0.05）. There were significant differences in operation time ［（136.3±32.5）min vs. （205.6±62.8）min］，postoperative hospital stay ［7.0（6.0, 10.0）d vs. 10.5（7.3,15.3）d］，incision infection (0 case vs 6 cases) and stoma complications (0 case vs 7 cases)(P<0.05). There was no significant difference in the above factors between those who converted to hernioscopic surgery after laparoscopic surgery and those who directly converted to open operation surgery（P>0.05）. Conclusion    Laparoscopic parastomal hernia repair using hernioscopy can reduce the conversion rate of laparoscopic surgery，which is safe and easy. It is a good supplementary technique in laparoscopic parastomal hernia repair. 

Key words: parastomal hernia, operation, laparoscopy, hernioscopy, conversion