中国实用外科杂志

中国实用外科杂志 ›› 2011, Vol. 31 ›› Issue (08): 748-751.

• 国际疝外科精粹 • 上一篇    下一篇

预防性植入合成补片在腹腔镜造口术中的应用

Janson AR1, Jänes A1, Israelsson LA2   

  1. 1 Department of Surgery, Kirurgkliniken, Sundsvalls sjukhus, 851 86 Sundsvall, Sweden; 2 Department of Surgery and Perioperative Science, Umea° University, Umea°, Sweden
  • 出版日期:2011-08-01 发布日期:2011-08-01

  • Online:2011-08-01 Published:2011-08-01

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摘要：

目的    探究腹腔镜造口术中预防性应用补片的效果。方法    将腹腔镜乙状结肠造口术中预防性地在腹膜外植入大孔径、轻量型补片的病例纳入研究。术后随访至少12个月。结果    2003-2007年共有25例病人接受了乙状结肠造口术。平均年龄为65（31~89）岁， BMI平均为26（21~32），其中15例为女性。术后1例病人发生造口坏死，2例发生轻度切口感染。在所有接受随访的20例中（平均随访时间19个月， 11~31个月），有3例（15%）发生了造口旁疝。无术后瘘管形成和造口狭窄，也未发生补片感染和再次手术移除补片的情况。结论    在腹腔镜造口术中预防性地在腹膜外植入大网孔、轻量型补片是简单安全的操作，并且能有效降低术后造口旁疝的发生率。

关键词: 腹腔镜造口术, 乙状结肠造口术 , 造口旁疝 , 腹壁疝

Abstract:

Laparoscopic stoma formation with a prophylactic prosthetic mesh        Janson AR*, Jänes A, Israelsson LA. *Department of Surgery, Kirurgkliniken, Sundsvalls sjukhus,851 86 Sundsvall, Sweden
Corresponding author: Janson AR, E-mail: alfred.janson@lvn.se
Abstract    objective    One year after stoma formation with an open technique, the rate of parastomal hernia is almost 50%. The herniation rate can be reduced to 10% with the use of a prophylactic mesh in a sublay position. For stomas formed with a laparoscopic technique, a surgical method with the use of prophylactic mesh should be sought. Methods    Patients with a sigmoidostomy created with a laparoscopic technique were provided with a prophylactic large-pore, low-weight mesh in a sublay position. Followup examination was carried out after at least 12 months. Results    Between March 2003 and May 2007, a sigmoidostomy was created in 25 patients. The patients’ mean age was 65 years (range 31-89), the mean body mass index was 26 (range 21-32) and 15 were female. One stoma necrosis and two minor wound infections occurred. Parastomal hernia was present in 3 of 20 patients (15%) available for follow-up examination after 11-31 months (mean 19). No fistulas or strictures had developed. No mesh infection was noted and no mesh was removed. Conclusion   In laparoscopic stoma formation, a prophylactic large-pore, low-weight mesh in a sublay position is an easy and safe procedure associated with a low rate of parastomal hernia.

Key words: laparoscopic stoma, sigmoid stoma, parastomal hernia, ventral hernia