目的:探讨预置疝补片对预防造口部位切口疝的作用。方法:回顾性分析2018年1月至2020年1月,共31例行回肠造口还纳患者的临床资料,其中对照组直接行造口还纳15例,实验组行回肠还纳术同时预置疝补片16例。结果:两组患者在出血量、术后住院时间、切口感染、腹腔感染、异物及疼痛感方面比较,差异无统计学意义(p > 0.05)。在手术时间上预置疝补片组长于对照组(p < 0.05),但在术后再发造口部位切口疝方面上,预置疝补片组明显优于对照组,差异有统计学意义(p < 0.05)。结论:在回肠造口还纳患者中行预置疝补片安全有效,可预防术后造口部位切口疝的发生,且并不增加术后并发症的发生率。 Objective: To investigate the preventive effects of Prophylactic hernia mesh placement in incisional hernia after ileostomy reversal. Methods: The clinical data of 31 patients with ileostomy reversal from December 2013 to December 2015 were retrospectively collected. Of the patients, 15 cases received control group with ileostomy reversal, 16 cases underwent ileostomy reversal and were placed the hernia mesh simultaneously. Results: No statistical difference was noted in intraoperative blood loss, hospitalization time, infection of incisional wound, intra-abdominal infection, foreign body sensation and pain sensation between the two groups (p > 0.05), the incidence rate of incisional hernia in prophylactic hernia mesh placement group was significantly lower than that control group (p < 0.05). Conclusions: The application of Prophylactic hernia mesh placement can effectively prevent the occurrence of incisional hernia after ileostomy reversal, with better curative effects and safety, and it does not increase the incidence of postoperative complications.
目的:探讨预置疝补片对预防造口部位切口疝的作用。方法:回顾性分析2018年1月至2020年1月,共31例行回肠造口还纳患者的临床资料,其中对照组直接行造口还纳15例,实验组行回肠还纳术同时预置疝补片16例。结果:两组患者在出血量、术后住院时间、切口感染、腹腔感染、异物及疼痛感方面比较,差异无统计学意义(p > 0.05)。在手术时间上预置疝补片组长于对照组(p < 0.05),但在术后再发造口部位切口疝方面上,预置疝补片组明显优于对照组,差异有统计学意义(p < 0.05)。结论:在回肠造口还纳患者中行预置疝补片安全有效,可预防术后造口部位切口疝的发生,且并不增加术后并发症的发生率。
回肠造口还纳,切口疝,疝补片
Tongtong Xu, Lianbang Zhou
The Second Affiliated Hospital of Anhui Medical University, Hefei Anhui
Received: Oct. 11th, 2021; accepted: Nov. 9th, 2021; published: Nov. 16th, 2021
Objective: To investigate the preventive effects of Prophylactic hernia mesh placement in incisional hernia after ileostomy reversal. Methods: The clinical data of 31 patients with ileostomy reversal from December 2013 to December 2015 were retrospectively collected. Of the patients, 15 cases received control group with ileostomy reversal, 16 cases underwent ileostomy reversal and were placed the hernia mesh simultaneously. Results: No statistical difference was noted in intraoperative blood loss, hospitalization time, infection of incisional wound, intra-abdominal infection, foreign body sensation and pain sensation between the two groups (p > 0.05), the incidence rate of incisional hernia in prophylactic hernia mesh placement group was significantly lower than that control group (p < 0.05). Conclusions: The application of Prophylactic hernia mesh placement can effectively prevent the occurrence of incisional hernia after ileostomy reversal, with better curative effects and safety, and it does not increase the incidence of postoperative complications.
Keywords:Ileostomy Reversal, Incisional Hernia, Patch
Copyright © 2021 by author(s) and Hans Publishers Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).
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造口部位切口疝指在行回肠造口还纳术后腹壁切口的筋膜和(或)肌层未能完全愈合,在腹内压作用下腹腔内器官或组织从原切口部位突出的疝,其发生率可达17.7% [
回顾性分析2018~2020安徽医科大学第二附属医院31例行回肠造口还纳的病例,分成两组,对照组15例,实验组16例,其中对照组回肠还纳后行肌层、筋膜单纯性的缝合,实验组行还纳后预置疝补片。实验组的16例患者中男10例,女性6例,年龄在54至78之间,平均年龄(66.8 ± 10.3)岁,对照组的15例患者中男11例,女4例,年龄在55至79之间,平均年龄(67.9 ± 10.6)岁,两组患者的性别、年龄、造口类型等一般资料的差异均无统计学意义,具有可比性。
1) 纳入标准:行末端回肠造口病人,末端回肠造口术后三月经ct、肠镜检查后明确无肿瘤复发、下端吻合口通畅。
2) 排除标准:肿瘤复发,下端吻合口狭窄,高龄体弱及其他手术禁忌致无法耐受还纳手术。
所有患者均于末端回肠造口术后三月明确无肿瘤复发、下端吻合口通畅后行回肠造口还纳。
1) 对照组:全麻下实施手术,术中用电刀沿造口周围皮肤梭形切开,将回肠造口完全游离出腹壁,于造瘘口两端小肠对系膜缘分别开一小口,用胃肠切割闭合器行行小肠侧侧吻合,再以切割闭合器离断移除造瘘口,可吸收线连续缝合关闭共同开口,而后予PDS线关闭腱膜。2) 实验组:既往手术步骤同对照组,在关闭腱膜后,充分游离腱膜至外侧5 cm,置入不可吸收疝补片。术后两组患者须使用腹带3月,并避免高腹压、重体力劳动,术后对患者进行定期门诊复查随访18个月。
采用SPSS 22.0统计软件进行统计学处理。计量资料采用均数 ± 标准差表示,计量资料用t检验,计数资料用x2检验。以p < 0.05为差异有统计学意义。
两组患者在出血量、术后住院时间、切口感染、腹腔感染、异物及疼痛感方面,差异无统计学意义(p > 0.05)。在手术时间上预置疝补片组长于对照组,但在术后再发造口部位切口疝方面上,预置疝补片组明显优于对照组,差异有统计学意义(p < 0.05),见表1。
例数 | 手术时间 min, x ¯ ± s | 术中出血量 ml, x ¯ ± s | 术后住院时间 d, x ¯ ± s | 切口感染 [例(%)] | 腹腔感染 [例(%)] | 异物及疼痛感 [例(%)] | 造口部位切口疝 [例(%)] | |
---|---|---|---|---|---|---|---|---|
对照组 | 15 | 106.7 ± 11.9 | 34.9 ± 11.8 | 7.3 ± 1.11 | 0 | 0 | 0 | 7 (46.7) |
实验组 | 16 | 129.3 ± 20.6 | 33.9 ± 11.5 | 7.6 ± 1.09 | 0 | 0 | 1 (6.25) | 0 |
p值 | <0.05 | >0.05 | >0.05 | - | - | >0.05 | <0.05 |
表1. 两组患者手术各项观察指标对比
结直肠癌在全世界范围内都是广泛存在的,结直肠癌是世界上第三大常见恶性肿瘤和第二大癌症死因 [
切口疝一旦发生基本没有自愈的可能,手术治疗是目前的主流,手术方式主要有腹壁筋膜单纯缝合修补术及疝补片植入修补术 [
本研究结果发现,预置疝补片组手术时间长于对照组(p < 0.05),可能是因为腱膜的游离及补片的放置增加了手术时间,此外,手术时间与操作者、助手的配合默契程度、操作技术熟练程度也密切相关。但随着手术团队配合默契程度的升高,术者本身的操作越来越熟练,应该能缩短一定手术时间。另外预置疝补片组有1例患者在术后出现术区腹壁的异物感及疼痛,嘱咐患者尽量采取斜坡卧位,以此降低腹壁张力,从而减少牵拉导致的疼痛,并及时予以使用适当的镇痛药物,症状得到了明显的缓解。术后20天内此患者的腹部不适感已好转消失,长期的随访观察未再诉有疼痛及异物感。在出血量、术后住院时间、切口感染、腹腔感染方面,两组间无明显差异。
但目前对于是否常规预置疝补片仍有一定的争议,疝补片为外来异物,植入患者体内后在一定程度上带来补片相关并发症,其中主要的就是补片相关的感染,补片一旦发生感染后可能面临着补片取出等问题,而预防性肠造口还纳手术为II类切口,发生术后切口感染可能性较高,如何避免这种情况的发生,首先,糖尿病患者因机体免疫功能下降和血糖浓度的升高易引起组织的水肿,同时给致病菌的生长和繁殖提供有利条件容易造成切口的感染 [
目前文献报道认为造口部位切口疝高发生率最明确的主要危险因素是肥胖 [
徐童童,周连帮. 预置疝补片对回肠造口还纳术后原造口部位切口疝的预防作用Preventive Effects of Prophylactic Hernia Mesh Placement in Incisional Hernia after Ileostomy Reversal[J]. 临床医学进展, 2021, 11(11): 5079-5083. https://doi.org/10.12677/ACM.2021.1111748