Department of Surgery, Kirurgkliniken, Sundsvalls Sjukhus, 851 86, Sundsvall, Sweden.
Hernia. 2011 Apr;15(2):189-92. doi: 10.1007/s10029-010-0769-6. Epub 2010 Dec 28.
Parastomal hernia is a frequent complication after stoma formation. No consistent definition of parastomal hernia has been used in previous studies using clinical examination or computed tomography (CT) scan. The correlation between herniation rates found with clinical examination and CT scan has been poor. A definition of parastomal hernia with clinical examination that correlates with findings from CT scan should be sought.
Parastomal hernia, was with surgeons' clinical examination, defined as any protrusion in the vicinity of the stoma with the patient straining in a supine and an erect position. A new CT scan method was developed with the patient examined in the prone position. Radiologists defined herniation as any intra-abdominal content protruding beyond the peritoneum or the presence of a hernia sac. The correlation between investigators and methods were estimated by calculating Fleiss' Kappa values.
Twenty-seven patients were assessed by three surgeons and three radiologists. For the surgeons, the Kappa value was 0.85. For the radiologists, it was 0.85 with CT scan in the prone position and 0.82 in the supine position. For the surgeons and radiologists collectively, the Kappa value was 0.80 for CT scan in the prone position and 0.63 in the supine position.
With the new CT scan method examining patients in the prone position, the clinical and radiological definitions were highly reproducible and correlated strongly between methods and raters. With the strong correlation between clinical and radiological assessments, clinical examination alone is sufficient as follow-up. Conventional CT scan with the patient supine is not a reliable tool for diagnosing parastomal hernia.
肠造口旁疝是造口术后常见的并发症。既往研究中，临床检查或计算机断层扫描（CT）检查使用的肠造口旁疝定义并不一致。临床检查和 CT 扫描发现的疝发生率之间相关性较差。应寻求一种与 CT 扫描结果相关的肠造口旁疝临床检查定义。
肠造口旁疝，由外科医生进行临床检查，定义为患者仰卧和直立位用力时，造口附近任何突出。开发了一种新的 CT 扫描方法，患者在俯卧位接受检查。放射科医生将疝定义为任何突出腹膜外的腹腔内容物或疝囊的存在。通过计算 Fleiss Kappa 值来评估研究者和方法之间的相关性。
27 例患者由 3 名外科医生和 3 名放射科医生进行评估。对于外科医生，Kappa 值为 0.85。对于放射科医生，在俯卧位时 CT 扫描的 Kappa 值为 0.85，仰卧位时为 0.82。对于外科医生和放射科医生的综合评估，俯卧位 CT 扫描的 Kappa 值为 0.80，仰卧位时为 0.63。
采用新的 CT 扫描方法对患者进行俯卧位检查时，临床和影像学定义具有高度可重复性，且方法和评估者之间相关性较强。临床和影像学评估之间具有较强的相关性，单独进行临床检查即可作为随访手段。传统的仰卧位 CT 扫描不是诊断肠造口旁疝的可靠工具。
