Lampel A, Runkel N
Klinik für Urologie & Kinderurologie, Schwarzwald-Baar-Klinikum Villingen-Schwenningen, Röntgenstraße 20, 78054 Villingen-Schwenningen, Deutschland.
Urologe A. 2012 Jul;51(7):965-70. doi: 10.1007/s00120-012-2962-y.
The incidence of parastomal hernia in ileal conduit urinary diversion ranges from 4% to 16%. Surgical correction is necessary in about one third of cases and different techniques of surgical reconstruction have been described. Primary fascial repair has a high recurrence rate of 46-100% whereas stoma translocation is associated with complication rates of up to 88%. The use of alloplastic material (usually polypropylene meshes) has reduced the recurrence rate by up to 100% for primary fascial repair and 71% for stoma translocation down to 33%.Composite meshes consist of two layers, a polypropylene layer and an expanded polytetrafluoroethylene (ePTFE) layer. The former is placed against the abdominal wall for permanent reinforcement by ingrowing connective tissue and the ePTFE layer is placed against the abdominal organs preventing adhesions with the bowel. The intraperitoneal placement of such composite meshes is a standardized, simplified, gentle and controllable surgical procedure. This article reports experiences with the surgical correction of parastomal hernias in ileal conduits using composite meshes.
回肠膀胱尿流改道术后造口旁疝的发生率为4%至16%。约三分之一的病例需要手术矫正，并且已经描述了不同的手术重建技术。一期筋膜修复的复发率很高，为46%至100%，而造口移位的并发症发生率高达88%。使用人工合成材料（通常是聚丙烯网片）已使一期筋膜修复的复发率降低了100%，使造口移位的复发率从71%降至33%。复合网片由两层组成，一层聚丙烯层和一层膨化聚四氟乙烯（ePTFE）层。前者贴靠腹壁放置，通过内生结缔组织进行永久性加固，而ePTFE层贴靠腹部器官放置，防止与肠道粘连。这种复合网片的腹腔内放置是一种标准化、简化、温和且可控的外科手术。本文报告了使用复合网片手术矫正回肠膀胱造口旁疝的经验。
