University of Exeter Medical School Exeter UK.
Department of Mathematics University of Exeter Exeter UK.
BJS Open. 2018 Oct 24;3(1):112-118. doi: 10.1002/bjs5.50109. eCollection 2019 Feb.
Development of a parastomal hernia is common following abdominoperineal excision (APE). The true incidence is difficult to assess fully owing to differing lengths of follow-up and techniques used to assess herniation; radiological or clinical. The primary aim of this study was to evaluate colostomy diameter by studying the rate of change of axial and sagittal trephine diameters, trephine area, and the ratio of the trephine over time. A secondary aim was to investigate variation in trephine area and variables affecting parasternal hernia over time.
Serial CT scans performed after APE from January 2006 to December 2014 were reviewed. Variables analysed included age, sex, trephine position relative to rectus abdominis muscle (RAM), type of incision for stoma creation, and axial and sagittal trephine diameters measured on follow-up CT. A Bayesian hierarchical modelling framework was used to examine the relationship of trephine diameters, area and ratio over time.
Of 112 patients undergoing APE, 103 were eligible for analysis; this included 91 colostomies (88·3 per cent) through the RAM and 12 (11·7 per cent) lateral to the RAM. Median age of the patients was 68 years. Sixty patients (58·3 per cent) had a circular and 43 (41·7 per cent) a cruciate incision for stoma creation. The sagittal trephine diameter increased by 0·22 (95 per cent credible interval 0·12 to 0·32) mm/month for both sexes. Women reported a significant increase in axial trephine diameters; the male : female ratio difference was -0·17 (-0·30 to -0·03) mm/month and for trephine areas -6·21 (0·96 to 13·7) mm/month. Patient age, colostomy trephine location and shape of incision were not statistically significant variables for parasternal hernia.
Female sex was the only variable affecting the rate of increase in axial trephine diameter and trephine area over time.
经腹会阴联合切除术（APE）后，发生造口旁疝较为常见。由于随访时间和评估疝的技术（影像学或临床）不同，很难全面评估真实发病率；原发目的本研究旨在通过研究轴向和矢状环钻直径、环钻面积以及随时间变化的环钻比值的变化率，评估结肠造口直径。次要目的是研究随时间变化的环钻面积和影响造口旁疝的变量。
回顾 2006 年 1 月至 2014 年 12 月 APE 后的连续 CT 扫描。分析的变量包括年龄、性别、环钻相对于腹直肌（RAM）的位置、造口切口类型、以及随访 CT 上测量的轴向和矢状环钻直径。采用贝叶斯层次模型框架来检验环钻直径、面积和比值随时间的关系。
在 112 例接受 APE 的患者中，有 103 例符合分析条件；其中 91 例（88.3%）通过 RAM 进行结肠造口，12 例（11.7%）位于 RAM 外侧。患者中位年龄为 68 岁。60 例（58.3%）患者采用圆形切口，43 例（41.7%）采用十字形切口。无论性别，矢状环钻直径每月增加 0.22（95%可信区间 0.12 至 0.32）mm。女性轴向环钻直径增加显著，男女差异为-0.17（-0.30 至-0.03）mm/月，环钻面积差异为-6.21（0.96 至 13.7）mm/月。患者年龄、结肠造口环钻位置和切口形状不是影响胸骨旁疝的统计学显著变量。
女性是影响轴向环钻直径和环钻面积随时间增加的唯一变量。
