腹腔镜造口旁疝IPST和Sugarbaker修补术的疗效比较

doi:10.3877/cma.j.issn.1674-6899.2026.02.004

目的

评价腹腔镜造口旁疝腹腔内补片覆盖修补术(interperitoneal onlay mesh technique, Dyna-Mesh IPST)术与Sugarbaker术的有效性和安全性。

方法

回顾性分析2020年1月至2023年6月上海交通大学医学院附属第九人民医院普外二科31例接受腹腔镜IPST术和Sugarbaker术修补的直肠癌Mile′s术后的造口旁疝患者的临床资料，其中IPST组16例(51.6%)，Sugarbaker组15例(48.4%)，收集患者的人口统计数据和术后并发症及术后主要观察目标——复发率，术后随访时间超过12个月。

结果

术后6个月内无死亡记录，Sugarbaker组1例(6.7%)因术后发热再入院并在随访期间保守恢复。Sugarbaker组复发率13.3%(2例)，而IPST组复发率12.5%(2例)，此外，在IPST组和Sugarbaker组之间未观察到术中细节和术后并发症，包括腹胀、切口感染、肠梗阻和肠瘘，或术后慢性疼痛及复发等发生率的差异。

结论

Sugarbaker和IPST术在造口旁疝的手术治疗中已被证明是有效的、易于操作的、安全的并且具有相似的临床疗效，特别是其低复发率。

关键词: 造口旁疝, 疝修补术, IPST, Sugarbaker, 复发率

Objective

To evaluate the efficacy and safety of laparoscopic intraperitoneal onlay mesh repair with the keyhole technique (IPST) versus the Sugarbaker technique for the treatment of parastomal hernia.

Methods

A retrospective analysis was conducted on 31 patients with parastomal hernia following abdominoperineal resection (Miles′ operation) for rectal cancer. These patients underwent laparoscopic repair, either with the IPST (n=16, 51.6%) or the Sugarbaker technique (n=15, 48.4%), in the Second Department of General Surgery, Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine, between Jan. 2020 and Jun. 2023. Patient demographic data, postoperative complications, and the primary outcome-recurrence rate-were collected. Postoperative follow-up exceeded 12 months.

Results

No mortality was recorded within 6 months postoperatively. One patient (6.7%) in the Sugarbaker group was readmitted due to postoperative fever and recovered conservatively during follow-up. The recurrence rate was 13.3%(2 cases) in the Sugarbaker group and 12.5%(2 cases) in the IPST group. Furthermore, no significant differences were observed between the IPST and Sugarbaker groups regarding intraoperative details or postoperative complications, including abdominal distension, surgical site infection, intestinal obstruction, enteric fistula, chronic postoperative pain, or recurrence.

Conclusions

Both the Sugarbaker and IPST techniques have been demonstrated to be effective, feasible, safe, and to yield similar clinical outcomes in the surgical management of parastomal hernia, particularly with respect to their low recurrence rates.

Key words: Parastomal Hernia, Herniorrhaphy, IPST, Sugarbaker, Recurrence rate

图1 IPST术修补流程注：A.造口旁疝CT影像图；B.暴露造口肠管及旁疝缺损；C. 1-0Vloc倒刺线缝合疝环缺损；D.缺损关闭后；E.补片贴合腹壁固定；F.缝合包绕肠管的3D"漏斗"结构，2-0prolene线加固

图2 Sugarbaker术修补注：A.粘连松解；B. 1-0Vloc倒刺线关闭缺损；C、D.补片固定

表1 纳入造口旁疝两组手术患者的基线特征变量

	IPST(n＝16)	Sugarbaker(n＝15)	P值
年龄(岁，±s)	78±7.1	77±5.3	0.38
BMI(kg/m²，±s)	22.6±1.3	23.5±1.5	0.08
性别(男/女)	10/6	9/6	0.89
EHS分类[例(%)]			0.38
Ⅰ	10(62.5)	7(46.7)
Ⅲ	6(37.5)	8(53.3)
合并症[例(%)]
高血压	6(37.5)	5(33.3)	0.81
糖尿病	5(31.2)	4(26.7)	0.10
冠心病	3(18.8)	2(13.3)	0.10

表1 纳入造口旁疝两组手术患者的基线特征变量

	IPST(n＝16)	Sugarbaker(n＝15)	P值
年龄(岁，±s)	78±7.1	77±5.3	0.38
BMI(kg/m²，±s)	22.6±1.3	23.5±1.5	0.08
性别(男/女)	10/6	9/6	0.89
EHS分类[例(%)]			0.38
Ⅰ	10(62.5)	7(46.7)
Ⅲ	6(37.5)	8(53.3)
合并症[例(%)]
高血压	6(37.5)	5(33.3)	0.81
糖尿病	5(31.2)	4(26.7)	0.10
冠心病	3(18.8)	2(13.3)	0.10

表2 Sugarbaker和IPST两组手术入路的术中和术后结果比

变量	IPST(n＝16)	Sugarbaker(n＝15)	P值
疝环缺损(cm，±s)	8.3±3.6	7.8±2.9	0.67
术中时间(min，±s)	210.5±41.2	190.5±48.7	0.23
术中出血量(ml，±s)	21.3±9.8	16.5±4.7	0.13
术后住院天(d，±s)	7.5±4.1	7.9±2.4	0.74
术后通气时间(d，±s)	3.5±1.3	3.9±1.1	0.36
并发症[例(%)]
腹胀	9(56.3)	8(53.3)	0.87
切口感染	2(12.5)	0	0.48
肠梗阻	3(18.8)	2(13.3)	1
肠瘘	0	0
术后慢性疼痛	2(12.5)	3(20.0)	0.65
复发率[例(%)]	2(12.5)	2(13.3)	1

表2 Sugarbaker和IPST两组手术入路的术中和术后结果比

变量	IPST(n＝16)	Sugarbaker(n＝15)	P值
疝环缺损(cm，±s)	8.3±3.6	7.8±2.9	0.67
术中时间(min，±s)	210.5±41.2	190.5±48.7	0.23
术中出血量(ml，±s)	21.3±9.8	16.5±4.7	0.13
术后住院天(d，±s)	7.5±4.1	7.9±2.4	0.74
术后通气时间(d，±s)	3.5±1.3	3.9±1.1	0.36
并发症[例(%)]
腹胀	9(56.3)	8(53.3)	0.87
切口感染	2(12.5)	0	0.48
肠梗阻	3(18.8)	2(13.3)	1
肠瘘	0	0
术后慢性疼痛	2(12.5)	3(20.0)	0.65
复发率[例(%)]	2(12.5)	2(13.3)	1

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Comparison of the efficacy of laparoscopic IPST and Sugarbaker repair for parastomal hernia

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Comparison of the efficacy of laparoscopic IPST and Sugarbaker repair for parastomal hernia