Sublay 法原位修补34例造口旁疝

-:IN SITU REPAIR OF PARASTOMAL HERNIA WITH SUBLAY METHODS IN 34 CASES

作者:刘飞德; 李基业; 姚胜; 朱瑛梅; 姚京 解放军总医院第一附属医院普外科(北京，100048) Author(s):LIU Feide; LI Jiye; YAO Sheng; ZHU Yingmei; YAO Jing. Department of General Surgery, the First Affiliated Hospital, General Hospital of Chinese PLA, Beijing, 100048, P.R.China.

关键词:造口旁疝; 疝修补; Sublay 法 Keywords:Parastomal hernia; Hernia repair; Sublay methods

摘要:

目的 总结采用Sublay 法原位修补造口旁疝的方法及疗效。

方法 2003 年2 月- 2009 年5 月，应用聚丙烯补片经原中线切口入路采用Sublay 法原位修补造口旁疝34 例。男23 例，女11 例;年龄43 ～ 78 岁，平均58.4岁。疝病史1 ～ 17 年，平均4.7 年。其中复发性造口旁疝6 例。疝环直径5 ～ 12 cm，平均7.2 cm。

结果 34 例均顺利完成Sublay 手术。手术时间96 ～ 160 min，平均116 min。术后12 h ～ 5 d 拔除胃管，平均3 d;术后2 ～ 7 d 拔除引流管，平均4 d。术后住院时间7 ～ 15 d，平均9 d。术后32 例切口Ⅰ期愈合;1 例切口中段脂肪液化，1 例切口感染，均经换药后愈合。7 例于术后3 ～ 7 d 发生补片上方浆液肿，经2 ～ 3 次穿刺并局部加压后消失。术后32 例获随访，随访时间6 ～ 75个月，平均32 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。2 例分别于术后3 个月和7 个月复发，经保守治疗及再次手术治愈;其余患者无复发。

结论 应用补片经原中线切口入路采用Sublay 法原位修补造口旁疝是一种安全、有效的方法。

Abstract:To summarize the therapeutic method and effectiveness of parastomal hernia repair in situ with sublay methods. Methods Between February 2003 and May 2009, 34 patients with parastoma hernia were treated with Sublay methods using primary midl ine incision approach and polypropylene patch. There were 23 males and 11 females with

an average age of 58.4 years (range, 43-78 years). The disease duration was 1 to 17 years (mean, 4.7 years). Of 34 patients, 6 had recurrent parastoma hernia. The diameter of hernia ring was 5-12 cm (mean, 7.2 cm). Results Sublay technique repair was successfully performed in all patients. The operative time was 96-160 minutes (mean, 116 minutes). The gastric tube was pulled out 12 hours to 5 days (mean, 3 days) after operation. The drainage tube was taken out at 2-7 days (mean, 4 days) after operation. The postoperative hospital ization time was 7 to 15 days (mean, 9 days). and the incisions of 32 patients healed by first intention. Incisional fat l iquefaction occurred in 1 case and infection in 1 case, and their incisions healed after dressing change. Seroma at the upper of the patch occurred in 7 patients and was cured by 2 to 3 times of percutaneous puncture and local pressure. Thirty-two patients were followed up 6-75 months (mean, 32 months). No chronic pain, lumping sensation, or local expansion in wound area occurred. Two recurrences occurred 3 months and 7 months after operation, respectively, and patients restored after expectant treatment or re-operation. Conclusion The in situ Sublay methods using primary midl ine incision approach and nonabsorbable patch is a feasible and safe method for parastomal hernia repair.