使用夹心技术同时保留回肠导管的端部造口的复发性旁乳头疝的腹腔镜修复 - 病例报告

Laparoscopic repair for recurrent parastomal hernia of an end stoma using the sandwich technique while preserving an ileal conduit- A case report

Abstract
INTRODUCTION:
Parastomal hernia is a common complication following stoma creation. The surgical approaches included local repair by suture, stoma relocation and mesh-based techniques; but none has been able to provide satisfactory results.
摘要
简介：
造口旁疝是一种常见的术后并发症。手术入路包括局部缝合修补术，造口搬迁和基于网格的技术，但没有一个是能够提供令人满意的结果。

PRESENTATION OF CASE:
A 60-year-old asian female was referred complaining of abdominal pain and constipation caused by recurrent parastomal hernia of an end stoma. She had undergone total cystectomy with creation of an ileal conduit at the age of 53 years, and laparoscopic sigmoid colostomy at the age of 55 years. Parastomal hernia of an end stoma had developed postoperatively, and she had undergone recreation of colostomy at the same place with fasciorrhaphy at the age of 59 years, but parastomal hernia recurred 6 months later because of split fascia sutures. Laparoscopic repair for recurrent parastomal hernia was conducted using the sandwich technique while preserving an ileal conduit. The patient has been followed postoperatively for more than 3 years without any sign of recurrence.
案例介绍：
一名60岁的亚裔女性在抱怨腹痛和便秘引起的端部造口的造口旁疝的复发。她经历了全膀胱切除术，在53岁时创建一个回肠导管，腹腔镜乙状结肠造口术在55岁。结束了造口造口旁疝术后，她在59岁时在同一地方接受了筋膜缝合术的结肠造口术，但造口旁疝复发6个月后，由于分离筋膜缝合。复发性造口旁疝腹腔镜修补术是采用夹层技术的同时保留了一个回肠。术后随访3年以上，无复发的迹象。

DISCUSSION:
Although further cases are required to get definitive conclusions, we suppose that the laparoscopic sandwich technique can be useful for parastomal hernia.
讨论：
虽然进一步的情况需要得到明确的结论，我们认为腹腔镜造口旁疝夹层技术可以是有用的。

CONCLUSION:
We herein report a case of recurrent parastomal hernia treated laparoscopically while preserving an ileal conduit using the sandwich technique which combines the keyhole and Sugarbaker techniques. This is a quite rare case report of laparoscopic repair for recurrent parastomal hernia in a patient with an ileal conduit.
结论：
我们在此报告一例复发性造口旁疝腹腔镜治疗的同时保持一个回肠采用夹层技术相结合的锁孔和Sugarbaker技术。这是一个与回肠造口旁疝腹腔镜修补术的患者复发的一个相当罕见的病例报告。

KEYWORDS:
Laparoscopic hernia repair; Parastomal hernia; Sandwich technique
关键词：
腹腔镜疝修补造口旁疝；夹层技术；

游客，如果您要查看本帖隐藏内容请回复

使用夹心技术同时保留回肠导管的端部造口的复发性旁乳头疝的腹腔镜修复 - 病例报告

Fig. 1. a) The patient had a large parastomal hernia in the left lower abdomen and an ileal conduit in the right lower abdomen. b) Abdominal CT scans showed a largeparastomal hernia of a stoma with herniation of transverse colon.
图1. a) 患者在左下腹部有一个大的造口旁疝和右下腹回肠。b）腹部CT扫描显示largeparastomal疝与横结肠造口疝。

使用夹心技术同时保留回肠导管的端部造口的复发性旁乳头疝的腹腔镜修复 - 病例报告

Fig. 2. Positioning of trocars, operator, and equipment for the laparoscopic surgery.
图2.定位孔，操作者，用于腹腔镜手术的设备。

使用夹心技术同时保留回肠导管的端部造口的复发性旁乳头疝的腹腔镜修复 - 病例报告

Fig. 3. Laparoscopic views of operation procedures.a) Laparoscopic views of a parastomal hernia and an ileal conduit. b) Greater omentum and transverse colon protruded into the hernia sac. c) A parastomal fascial gap wascompletely freed. Dotted line indicates a parastomal fascial gap.
图3.腹腔镜手术操作程序。a)造口旁疝和回肠导管的腹腔镜视图。b）大网膜和横结肠突入疝囊。C）一个造口旁筋膜间隙完全释放。虚线表示造口旁筋膜间隙。

使用夹心技术同时保留回肠导管的端部造口的复发性旁乳头疝的腹腔镜修复 - 病例报告

Fig. 4. Operation procedures of the sandwich technique.a) Composite mesh was applied by the keyhole technique. Laparoscopic views (left) and its illustration figures (right). b) A further mesh (central band type) was overlaid tocover the first mesh and the whole abdominal wall by the Sugarbaker technique. Laparoscopic views (left) and its illustration figures (right). In illustration figures (right),purple lines represent stay sutures, while blue circles do absorbable tacks.
图4.夹层技术的操作程序。a) 复合网格应用的小孔技术。腹腔镜的意见（左）和它的插图数字（右） b)进一步的网格（中央带式）叠加覆盖第一网由Sugarbaker技术全腹壁。腹腔镜的视图（左）和它的插图数字（右）。在插图（右），紫色线代表留缝，而蓝色的圆圈可吸收钉。

使用夹心技术同时保留回肠导管的端部造口的复发性旁乳头疝的腹腔镜修复 - 病例报告

Fig. 5. Abdominal CT scans showed no recurrence for more than 3 years aftersurgery.
图5.腹部CT扫描显示术后3年以上无复发。