【摘要】 目的探讨预防性应用防粘连补片对结肠造口术后造口旁疝发生率的影响。方法选取2014年12月至2015年3月,潮州市中心医院行腹腔镜下腹会阴联合切除加末端结肠造口术的直肠癌82例患者临床资料,随机分为处理组与对照组,每组患者41例。对照组患者接受传统末端结肠造口术,处理组患者在传统末端结肠造口术的基础上加用防粘连补片固定于造口周围。评价并记录患者术后12个月内造口旁疝发生情况和分型,造口相关并发症,造口周围疼痛程度和造口孔洞面积。结果在术后12个月内,处理组的Ⅰ型与Ⅲ型造口旁疝发生率较对照组降低,差异有统计学意义(P<0.05),而2组Ⅱ型与Ⅳ型造口旁疝发生率比较,差异无统计学意义(P>0.05);处理组与对照组造口相关并发症:出血、脱垂、狭窄、回缩和造口周围皮肤炎症的发生率比较,差异无统计学意义(P>0.05);2组术后第1、12个月的造口周围疼痛VAS评分比较,差异无统计学意义(P>0.05);处理组与对照组术后第1个月造口孔面积比较,差异无统计学意义(P>0.05),而在术后第12个月对照组患者造口孔面积显著大于处理组(P<0.05)。结论回结肠末端造口术中应用防粘连补片可以降低术后早期造口旁疝的发生率,且不增加其他造口相关的并发症,是一种安全有效的预防造口旁疝的方法,值得进一步推广和研究。更多还原

【Abstract】 Objective To investigate the influence of prophylactic anti-adhesion mesh on the incidence of parastomal hernia after colostomy. Methods From December 2014 to March 2015,82 patients with rectal cancer who received laparoscopic abdominoperineal resection in Chaozhou Central Hospital,were randomly divided into treatment group and control group. There were 41 patients in each group. Patients in control group received classical colostomy,while patients in treatment group received classical colostomy combined with placement of a dual-component anti-adhesion mesh around the stoma. The classification and incidence of parastomal hernia,stoma-related complications,pain degree of the stoma and stoma orifice size were evaluated and recorded. Results Within the first 12 months after the operation,the incidence of typeⅠ,Ⅲ parastomal hernia in treatment group were lower than those in the control group( P < 0. 05),while incidence of type II,IV parastomal hernia of treatment group were similar with the control group( P > 0. 05).The incidence of stoma-related bleeding,prolapse,stenosis,retraction and skin inflammation were similar between the two groups( P > 0. 05). There was no statistically significant difference in VAS scores between the two groups at 1st and 12 th month after operation( P > 0. 05). The stoma orifice size were similar between the two groups at 1st month( P > 0. 05). But at 12 th month postoperatively,it was larger in the control group( P < 0. 05). Conclusion It is a safe and effective method to prevent parastomal hernia with the application of the prophylactic anti-adhesion mesh during colostomy,which can decrease the incidence of parastomal hernia in the early stage after operation without any additional stoma-related complications,and it should be popularized.更多还原