造口回纳术后疝的发生率、复发率及危险因素
Incidence, recurrence and risk factors of hernias following stoma reversal.
作者信息
Oriel Brad S, Chen Qi, Itani Kamal M F
机构信息
Department of Surgery, VA Boston Healthcare System, West Roxbury, MA, USA; Department of Surgery, Tufts University School of Medicine, Boston, MA, USA.
Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA.
出版信息
Am J Surg. 2017 Aug;214(2):232-238. doi: 10.1016/j.amjsurg.2017.04.014. Epub 2017 Jun 3.
BACKGROUND
To determine the incidence and risk factors for stoma site (SSH) and incisional (IH) hernias following stoma reversal as well as their recurrence following repair.
METHODS
A cohort of VA Surgical Quality Improvement Program patients undergoing stoma reversal from 2002 to 2014 were evaluated at a single institution. Variables were selected a priori and evaluated by univariate analyses.
RESULTS
Of 114 stoma reversals, 63 utilized a midline approach. The incidence of SSH and IH was 9.6% and 31.7% over a median follow-up of 5.7 (0.5-14) and 4.0 (0.1-14) years, respectively. Five SSH and 10 IH were repaired with no recurrences. Myofascial release and superficial surgical site infections (SSI) were associated with SSH while body mass index, preoperative radiotherapy, American Society of Anesthesiologists classification ≥3, operative duration ≥2.5 h and deep SSIs were associated with IH.
CONCLUSIONS
Incisional hernia incidence after stoma reversal is high for both the stoma site and midline. Risk factors differ for each hernia type. A low recurrence rate exists in short term follow-up following repair of a hernia occurrence.
背景
确定造口回纳术后造口部位（SSH）和切口疝（IH）的发生率及危险因素，以及修复后的复发情况。
方法
对2002年至2014年在单一机构接受造口回纳术的退伍军人事务部外科质量改进计划患者队列进行评估。预先选择变量并通过单因素分析进行评估。
结果
在114例造口回纳术中，63例采用中线入路。在中位随访时间分别为5.7（0.5 - 14）年和4.0（0.1 - 14）年时，SSH和IH的发生率分别为9.6%和31.7%。5例SSH和10例IH接受了修复，无复发。肌筋膜松解和浅表手术部位感染（SSI）与SSH相关，而体重指数、术前放疗、美国麻醉医师协会分级≥3、手术持续时间≥2.5小时和深部SSI与IH相关。
结论
造口回纳术后，造口部位和中线的切口疝发生率均较高。每种疝类型的危险因素不同。疝发生修复后的短期随访中复发率较低。
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