1.中山大学附属第六医院 普通外科(疝和腹壁外科)，广东 广州 510655;2.广东省结直肠盆底疾病研究重点实验室，广东 广州 510655;3.广州市黄埔区中六生物医学创新研究院，广东 广州 510655
1.Department of General Surgery (Hernia and Abdominal Wall Surgery), the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China;2.Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou 510655, China;3.Guangzhou Zhongliu Biomedical Innovation Center, Guangzhou 510655, China
背景与目的 造口旁疝是肠造口术后的常见并发症，腹腔镜Sugarbaker修补术是目前主流的手术方式，而如何缝合关闭筋膜缺损是手术最大的难点。常规的缝合关闭技术存在闭合或缩小缺损困难、术后血清肿发生率高、腹壁塑形效果差等不足。笔者中心在前期应用“立体缝合”技术缝合关闭缺损，可以较好地解决上述问题。本研究通过对比造口旁疝腹腔镜Sugarbaker修补术中应用“立体缝合”技术和常规缝合技术的两组患者的临床疗效，探讨“立体缝合”技术在造口旁疝修补术中的临床价值。方法 回顾性分析2018年1月—2021年12月中山大学附属第六医院疝和腹壁外科行腹腔镜Sugarbaker修补术的造口旁疝患者资料，其中44例采用“立体缝合”关闭缺损（研究组），29例采用传统缝合方法关闭缺损（对照组），比较两组患者的相关临床指标。结果 研究组均实现了筋膜缺损的完全关闭，对照组无法完全关闭缺损9例（31.0%）；研究组平均关闭筋膜缺损缝合时间（47.45±10.44）min，平均手术时间（132.14±13.72）min，对照组平均关闭筋膜缺损缝合时间为（33.72±8.64）min，平均手术时间（113.97±18.30）min，两组以上指标差异均有统计学意义（均P<0.001）。研究组术后血清肿发生率明显低于对照组（6.8% vs. 27.6%，P=0.036），两组术后补片感染发生率差异无统计学意义（2.3% vs. 3.4%，P=0.640）。研究组术后复发率明显低于对照组（2.3% vs. 20.7%，P=0.027）。研究组术后住院时间6（5~7）d，住院费用为（72 998.79±15 352.46）元，对照组术后住院时间6（5~7）d，住院费用为（72 998.79±11 542.77）元，两组间该两项指标差异均无统计学意义（P=0.447，P=0.708）。结论 立体缝合技术应用于造口旁疝修补术中，可有效关闭筋膜缺损，减少术后血清肿和复发的发生率。
Background and Aims Parastomal hernia is a common complication following intestinal stoma creation. The laparoscopic Sugarbaker procedure is currently the mainstream surgical approach, and the biggest challenge lies in how to suture and close the fascial defect. Conventional suture closure techniques have limitations such as difficulty in closing or reducing the defect, high incidence of postoperative seroma formation, and poor abdominoplasty outcome. In our center, we have successfully addressed these issues by utilizing the " multidimensional suturing" technique to close the defect. This study was performed to compare the clinical efficacy of the "multidimensional suture" technique with conventional suture technique in the laparoscopic Sugarbaker repair of parastomal hernia, to assess the clinical value of the "multidimensional suture" technique in parastomal hernia repair.Methods The data of patients with parastomal hernia who underwent laparoscopic Sugarbaker repair in the Department of Hernia and Abdominal Wall Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University from January 2018 to December 2021 were retrospectively analyzed. Of the patients, 44 cases received a "multidimensional suture" for the treatment of hernia sac and defect (study group), and 29 cases underwent the conventional suture method for the defect closure (control group). The main clinical variables were compared between the two groups of patients.Results The fascia defects were completely closed in all patients in the study group, while 9 patients (31.0%) failed to achieve complete defect closure in the control group. The average time for fascial defect closure was (47.45±10.44) min in the study group and (33.72±8.64) min in the control group. The average operative time was (132.14±13.72) min in the study group and (113.97±18.30) min in the control group. The differences in these variables between the two groups were statistically significant (all P<0.001). The postoperative seroma formation rate in the study group was significantly lower than that in the control group (6.8% vs. 27.6%, P=0.036). The incidence of mesh infection after surgery showed no statistically significant difference between the two groups (2.3% vs. 3.4%, P=0.640). The study group had a significantly lower postoperative recurrence rate compared to the control group (2.3% vs. 20.7%, P=0.027). The postoperative hospital stay was 6 (5-7) d in both the study and control groups, and the hospital costs were (72 998.79±15 352.46) yuan and (72 998.79±11 542.77) yuan in the study group and the control group, respectively. There were no statistically significant differences in these two variables between the two groups (P=0.447, P=0.708).Conclusion Applying the "multidimensional suture" technique in laparoscopic Sugarbaker repair of parastomal hernia can effectively close the fascia defect and reduce the risk of postoperative seroma and recurrence.