Cingi Asim, Cakir Tebessum, Sever Ali, Aktan A Ozdemir
Department of General Surgery, Marmara University Hospital, Istanbul 34662, Turkey.
Dis Colon Rectum. 2006 Oct;49(10):1559-63. doi: 10.1007/s10350-006-0681-4.
Parastomal hernia continues to be an important clinical problem with a reported incidence of up to 50 percent. In studies using computerized tomography in selected cases for detection of parastomal hernia, physical examination alone was underestimating the true incidence. Also after closure of the enterostomy, the ostomy site could still be a potential area of herniation. In this study in addition to physical examination, we used computerized tomography to determine the true incidence of parastomal hernia and ostomy closure site hernias.
We examined patients with enterostomies and with closed enterostomy sites both with physical examination and computerized tomography for the detection of hernias, hernia content, and relation to rectus muscles. Risk factors for hernia formation, such as age, gender, body mass index, associated medical problems, and surgical site infections, were determined.
Evaluation of 23 patients with ostomies resulted in 52 percent incidence of parastomal hernia, whereas the addition of tomography examination gave a corrected incidence of 78 percent. In a second subset of 23 patients with closed ostomies, although 26 percent of the patients were found to have ostomy site hernias with physical examination alone, this incidence increased to 48 percent when combined with computerized tomography. The potential risk factors for hernia formation, such as body mass index, surgical site infection, and ostomy site whether pararectus or transrectus, were not proven to have a significant role in this study.
Parastomal hernia and closed ostomy site incisional hernias have a high incidence, and computerized tomography has been shown to be a valuable diagnostic tool.
造口旁疝仍然是一个重要的临床问题，报告的发病率高达50%。在一些研究中，通过计算机断层扫描对特定病例进行造口旁疝检测时，仅体格检查会低估其真实发病率。而且在肠造口关闭后，造口部位仍可能是疝形成的潜在区域。在本研究中，除了体格检查外，我们还使用计算机断层扫描来确定造口旁疝和造口关闭部位疝的真实发病率。
我们对有肠造口和已关闭造口部位的患者进行了体格检查和计算机断层扫描，以检测疝、疝内容物以及与腹直肌的关系。确定了疝形成的危险因素，如年龄、性别、体重指数、相关的医疗问题和手术部位感染。
对23例有造口的患者进行评估，造口旁疝的发病率为52%，而加上断层扫描检查后校正发病率为78%。在另一组23例已关闭造口的患者中，尽管仅通过体格检查发现其中26%的患者有造口部位疝，但结合计算机断层扫描后，这一发病率增至48%。在本研究中，未证实体重指数、手术部位感染以及造口部位是腹直肌旁还是经腹直肌等疝形成的潜在危险因素具有显著作用。
造口旁疝和已关闭造口部位的切口疝发病率很高，计算机断层扫描已被证明是一种有价值的诊断工具。
