【摘要】 目的 造口旁疝是肠造口术后常见的远期并发症，本研究比较腹腔镜与开放结合的肠造口旁疝补片修补术式(Lap-re-Do术式)这一本团队创新术式，与其他相关术式在复发率和术后并发症发生情况方面的差异，以期寻求治疗造口旁疝的优化方案。方法 回顾性分析于2004年9月—2019年12月在复旦大学附属华山医院普通外科疝专科行造口旁疝修补手术的330例患者的临床资料。纳入患者的肠造口类型分别为结肠造口(289例)、回肠代膀胱造口(35例)和回肠造口(6例)。依据病史和手术类型(包括开放式修补手术、全腹腔镜修补手术、Lap-re-Do术式及补片置放方法),记录造口类型、手术方式、术中并发症等信息。术后进行电话随访，了解术后并发症和复发情况，根据需要行门诊随访。主要随访终点为造口旁疝复发，次要随访终点为患者死亡。结果 261例完成随访的患者年龄为(66±7)岁，其中男性133例(51.0%),随访时间为(39±20)个月，复发65例，总体复发率为24.9%(65/261)。行开放式修补术的患者完整随访27例，行全腹腔镜修补术的患者完整随访53例，行Lap-re-Do术式的患者完整随访181例。行全腹腔镜修补手术和Lap-re-Do术式患者疾病复发的比例均显著低于行开放式修补手术的患者(χ~2=0.036、0.043,P值均<0.05)。行Lap-re-Do Keyhole的患者完整随访101例，行Lap-re-Do Sugarbaker的患者完整随访71例，行Lap-re-Do缝合修补的患者完整随访9例。行Lap-re-Do Sugarbaker患者疾病复发的比例显著低于行Lap-re-Do Keyhole患者(χ~2=4.083,P值均<0.05);而行缝合修补的患者疾病复发比例与前两组患者的差异均无统计学意义(P值均>0.05)。行开放式手术的患者术后并发症为不全肠梗阻、伤口液化、造口塌陷。行全腹腔镜修补手术的患者术后并发症为浆液肿、造口狭窄、造口脱垂、不全肠梗阻、造口袋贴合不牢。Lap-re-Do Keyhole术后并发症为感染、肠梗阻、造口狭窄塌陷。Lap-re-Do Sugarbaker术后并发症为感染、不全肠梗阻、造口缺血、排便困难。结论 Lap-re-Do Sugarbaker在结肠造口旁疝修补中的应用安全有效，各方法的最佳临床应用指征仍待进一步研究。更多还原

【Abstract】 Objective Parastomal hernia is a common long-term complication after enterostomy. In this study, we aimed to explore the therapeutic effect of Lap-re-Do, an innovative parastomal hernia repair, in repairing parastomal hernia, and to compare the recurrence rate and postoperative complications between Lap-re-Do and other related procedures. Methods Clinical data of 330 patients who underwent parastomal hernia repair in the Hernia Department of Huashan Hospital Affiliated to Fudan University from September 2004 to December 2019 were retrospectively analyzed. There were 289 cases of colostomy, 35 cases of ileal bladder replacement and 6 cases of ileostomy. According to the medical history and surgical types(including open repair surgery, laparoscopic repair surgery Lap-re-Do and the method of placing mesh), the type of stoma, surgical method, intraoperative complications and other information were recorded. Telephone follow-up was conducted after surgery to survey postoperative complications and recurrence, and outpatient follow-up was conducted as needed. The primary follow-up endpoint was parastomal hernia recurrence, and the secondary endpoint was death. Results A total of 261 patients completed the follow-up. Their mean age was(66±7) years old, and 133 patients(51.0%) were male. The mean duration of follow-up was(39±20) months. The overall recurrence rate was 24.9%(65/261). Of them, 27 patients underwent open repair, 53 patients underwent total endoscopic repair, and 181 patients underwent Lap-re-Do(including Lap-re-Do Keyhole in 101 patients, Lap-re-Do Sugarbaker in 71 and Lap-re-Do suture repair in 9). The recurrence rates in patients undergoing total laparoscopic repair surgery and Lap-re-Do were significantly lower than that in patients undergoing open repair surgery(χ~2=0.036, 0.043, both P<0.05). The recurrence rate in patients undergoing Lap-re-Do Sugarbaker was significantly lower than that in patients undergoing Lap-re-Do Keyhole(χ~2=4.083, P<0.05); the proportion of recurrence in patients undergoing suture repair was higher than those in the other two groups, but the difference was not statistically significant(P>0.05). The main complications of open surgery were incomplete intestinal obstruction, wound liquefaction, and stoma collapse. The main complications of total endoscopic repair surgery are serous edema, stoma stenosis, stoma prolapse, incomplete intestinal obstruction, and poor fit of the ostomy bag. The main complications of Lap-re-Do Keyhole were infection, intestinal obstruction, and collapse of stoma stenosis. The main complications of Lap-re-Do Sugarbaker were infection, incomplete ileus, stoma ischemia, and difficult defecation. Conclusion Lap-re-Do Sugarbaker is a safe and effective paracolostomy for parastomal repair. The optimal clinical indications for each method need to be further studied.更多还原