Rubin M S, Schoetz D J, Matthews J B
Department of Colorectal Surgery, Lahey Clinic, Burlington, Mass.
Arch Surg. 1994 Apr;129(4):413-8; discussion 418-9. doi: 10.1001/archsurg.1994.01420280091011.
To evaluate methods of parastomal hernia repair.
Retrospective analysis.
Two tertiary care institutions.
Eighty patients undergoing 94 parastomal hernia repairs between 1983 and 1991.
Three methods of repair were examined: fascial repair, stoma relocation, and fascial repair with prosthetic material.
Parastomal hernia recurrence and short- and long-term complications.
Fifty-five (93%) of 59 living patients were available and examined at a median of 31.5 months following repair, providing 68 repairs for consideration. Fascial repair was used in 36 cases, stoma relocation in 25 cases, and fascial repair with prosthetic material in seven cases. Overall, 63% of patients developed a recurrent parastomal hernia and 63% had at least one postoperative complication. Following first-time repair, parastomal hernia recurrence developed in 22 (76%) of 29 patients who had fascial repair but in only six (33%) of 18 patients who had stoma relocation (P < .01). When repair was undertaken for recurrent parastomal hernia, fascial repair failed in all seven cases, stoma relocation failed in five (71%) of seven cases, and fascial repair with prosthetic material failed in one (33%) of three cases. The only factor that significantly affected the recurrence rate was the technique of repair. Complications were more common following stoma relocation (88%) than following fascial repair (50%) (P < .05). In particular, incisional hernias developed in 52% of patients following stoma relocation but in only 3% of patients following fascial repair. When postoperative occurrence of all abdominal-wall hernias was compared, there was no significant difference between the fascial repair group (29 [81%] of 36 repairs) and the stoma relocation group (17 [68%] of 25 repairs). Furthermore, the reoperation rate for hernia repair was nearly identical (31% vs 28%) between these two groups.
Parastomal hernia repair is often unsuccessful and rarely without complication. For first-time parastomal hernia repairs, stoma relocation is superior to fascial repair. For recurrent parastomal hernias, repair with prosthetic material is the most promising of a group of poor alternatives.
评估造口旁疝修补方法。
回顾性分析。
两家三级医疗机构。
1983年至1991年间80例患者接受了94次造口旁疝修补术。
研究了三种修补方法：筋膜修补、造口移位和使用人工材料的筋膜修补。
造口旁疝复发及短期和长期并发症。
59例存活患者中有55例（93%）在修补术后中位时间31.5个月时接受检查，共68次修补可供分析。36例采用筋膜修补，25例采用造口移位，7例采用使用人工材料的筋膜修补。总体而言，63%的患者出现造口旁疝复发，63%的患者至少有1种术后并发症。首次修补后，29例接受筋膜修补的患者中有22例（76%）出现造口旁疝复发，而18例接受造口移位的患者中只有6例（33%）复发（P<0.01）。复发性造口旁疝修补时，7例筋膜修补全部失败，7例造口移位中有5例（71%）失败，3例使用人工材料的筋膜修补中有1例（33%）失败。唯一显著影响复发率的因素是修补技术。造口移位后并发症（88%）比筋膜修补后（50%）更常见（P<0.05）。特别是，造口移位后52%的患者发生切口疝，而筋膜修补后仅3%的患者发生。比较所有腹壁疝的术后发生率，筋膜修补组（36次修补中的29例[81%]）和造口移位组（25次修补中的17例[68%]）之间无显著差异。此外，这两组疝修补的再次手术率几乎相同（31%对28%）。
造口旁疝修补术常不成功，且很少无并发症。对于首次造口旁疝修补，造口移位优于筋膜修补。对于复发性造口旁疝，使用人工材料修补是一组较差选择中最有希望的方法。
