永久性乙状结肠造口术后造口旁疝的外科治疗现状及展望
Surgical Management of Parastomal Hernia Following Permanent Sigmoid Colostomy: Current Status and Future Perspectives
DOI: 10.12677/acm.2026.161211, PDF,   
作者: 袁浩岚*, 魏正强#:重庆医科大学附属第一医院胃肠外科,重庆
关键词: 结肠造口旁疝疝修补术补片预防Parastomal Hernia Herniorrhaphy Mesh Prevention
摘要: 在需要接受永久性乙状结肠造口术的结直肠癌患者中,造口旁疝是术后最常见的远期并发症之一。针对这一问题,临床上的干预措施主要分为预防性和治疗性。预防性的措施主要是预防性放置补片和腹膜外造口;治疗性的措施主要是造口旁疝的修补术,而修补术又是多种多样。此篇文献的目的在于总结目前已知的针对永久性乙状结肠造口旁疝的外科治疗现状及展望。
Abstract: Parastomal hernia represents one of the most frequent long-term complications following permanent sigmoid colostomy in patients with colorectal cancer. Clinical management of this issue is primarily divided into preventive and therapeutic strategies. Preventive measures mainly include prophylactic mesh placement and extraperitoneal stoma formation. Therapeutic interventions focus on the repair of parastomal hernia, for which a diverse array of surgical techniques exists. The purpose of this article is to review the current state of surgical management for parastomal hernia after permanent sigmoid colostomy and to discuss future perspectives.
文章引用:袁浩岚, 魏正强. 永久性乙状结肠造口术后造口旁疝的外科治疗现状及展望[J]. 临床医学进展, 2026, 16(1): 1657-1663. https://doi.org/10.12677/acm.2026.161211

参考文献

[1] Londono-Schimmer, E.E., Leong, A.P.K. and Phillips, R.K.S. (1994) Life Table Analysis of Stomal Complications Following Colostomy. Diseases of the Colon & Rectum, 37, 916-920. [Google Scholar] [CrossRef] [PubMed]
[2] Carne, P.W.G., Robertson, G.M. and Frizelle, F.A. (2003) Parastomal Hernia. British Journal of Surgery, 90, 784-793. [Google Scholar] [CrossRef] [PubMed]
[3] Rubin, M.S., Schoetz, D.J. and Matthews, J.B. (1994) Parastomal Hernia. Is Stoma Relocation Superior to Fascial Repair? Archives of Surgery (Chicago, Ill: 1960), 129, 413-418. [Google Scholar] [CrossRef] [PubMed]
[4] Goligher, J.C. and Hughes, E.S. (1951) Sensibility of the Rectum and Colon. Its Role in the Mechanism of Anal Continence. The Lancet (London, England), 1, 543-547. [Google Scholar] [CrossRef] [PubMed]
[5] Funahashi, K., Suzuki, T., Nagashima, Y., Matsuda, S., Koike, J., Shiokawa, H., et al. (2013) Risk Factors for Parastomal Hernia in Japanese Patients with Permanent Colostomy. Surgery Today, 44, 1465-1469. [Google Scholar] [CrossRef] [PubMed]
[6] Hansson, B.M.E., Slater, N.J., van der Velden, A.S., Groenewoud, H.M.M., Buyne, O.R., de Hingh, I.H.J.T., et al. (2012) Surgical Techniques for Parastomal Hernia Repair: A Systematic Review of the Literature. Annals of Surgery, 255, 685-695. [Google Scholar] [CrossRef] [PubMed]
[7] Antoniou, S.A., Agresta, F., Garcia Alamino, J.M., Berger, D., Berrevoet, F., Brandsma, H., et al. (2017) European Hernia Society Guidelines on Prevention and Treatment of Parastomal Hernias. Hernia, 22, 183-198. [Google Scholar] [CrossRef] [PubMed]
[8] Abdelsamad, A., Mohammed, M.K., Almoshantaf, M.B., Alrawi, A., Fadl, Z.A., Tarek, Z., et al. (2025) Parastomal Hernia: Direct Repair versus Relocation: Is Stoma Relocation Worth the Risk? A Comparative Meta-Analysis and Systematic Review. Updates in Surgery. [Google Scholar] [CrossRef] [PubMed]
[9] Allen-Mersh, T.G. and Thomson, J.P.S. (1988) Surgical Treatment of Colostomy Complications. Journal of British Surgery, 75, 416-418. [Google Scholar] [CrossRef] [PubMed]
[10] Rosin, J.D. and Bonardi, R.A. (1977) Paracolostomy Hernia Repair with Marlex Mesh: A New Technique. Diseases of the Colon & Rectum, 20, 299-302. [Google Scholar] [CrossRef] [PubMed]
[11] Jani, K. (2010) Laparoscopic Paracolostomy Hernia Repair: A Retrospective Case Series at a Tertiary Care Center. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 20, 395-398. [Google Scholar] [CrossRef] [PubMed]
[12] Olmi, S., Oldani, A., Uccelli, M., Scotto, B., Cesana, G., Ciccarese, F., et al. (2019) Laparoscopic Modified Keyhole Technique with Coated Polyester Mesh for Treatment of Parastomal Hernia: Measures for Improving the Outcome. Journal of Laparoendoscopic & Advanced Surgical Techniques, 29, 681-684. [Google Scholar] [CrossRef] [PubMed]
[13] Sugarbaker, P.H. (1985) Peritoneal Approach to Prosthetic Mesh Repair of Paraostomy Hernias. Annals of Surgery, 201, 344-346. [Google Scholar] [CrossRef] [PubMed]
[14] DeAsis, F.J., Lapin, B., Gitelis, M.E., et al. (2015) Current State of Laparoscopic Parastomal Hernia Repair: A Meta-analysis. World Journal of Gastroenterology, 21, 8670-8677. [Google Scholar] [CrossRef] [PubMed]
[15] Berger, D. and Bientzle, M. (2007) Laparoscopic Repair of Parastomal Hernias: A Single Surgeon's Experience in 66 Patients. Diseases of the Colon & Rectum, 50, 1668-1673. [Google Scholar] [CrossRef] [PubMed]
[16] Kritharides, N., Papaconstantinou, D., Kykalos, S., Machairas, N., Schizas, D., Nikiteas, N.I., et al. (2023) Laparoscopic Parastomal Hernia Repair: Keyhole, Sugarbaker, Sandwich, or Hybrid Technique with 3D Mesh? an Updated Systematic Review and Meta-analysis. Langenbeck's Archives of Surgery, 408, 448. [Google Scholar] [CrossRef] [PubMed]
[17] Abdelsamad, A., Mohammed, M.K., Almoshantaf, M.B., Alrawi, A., Fadl, Z.A., Tarek, Z., et al. (2025) Minimally Invasive versus Open Parastomal Hernia Repair: A Comprehensive Systematic Review and Meta‐Analysis. World Journal of Surgery, 49, 2382-2398. [Google Scholar] [CrossRef] [PubMed]
[18] Lai, T., Roxburgh, C., Boyd, K.A. and Bouttell, J. (2024) Clinical Effectiveness of Robotic versus Laparoscopic and Open Surgery: An Overview of Systematic Reviews. BMJ Open, 14, e076750. [Google Scholar] [CrossRef] [PubMed]
[19] Olavarria, O.A., Bernardi, K., Shah, S.K., Wilson, T.D., Wei, S., Pedroza, C., et al. (2020) Robotic versus Laparoscopic Ventral Hernia Repair: Multicenter, Blinded Randomized Controlled Trial. BMJ, 370, m2457. [Google Scholar] [CrossRef] [PubMed]
[20] Marinez, A.C., González, E., Holm, K., Bock, D., Prytz, M., Haglind, E., et al. (2016) Stoma-Related Symptoms in Patients Operated for Rectal Cancer with Abdominoperineal Excision. International Journal of Colorectal Disease, 31, 635-641. [Google Scholar] [CrossRef] [PubMed]
[21] 唐健雄, 李绍杰. 造口旁疝的防治进展[J]. 临床外科杂志, 2013(6): 3.
[22] Brandsma, H., Hansson, B.M., Haan, H.V., Aufenacker, T.J., Rosman, C. and Bleichrodt, R.P. (2012) Prevention of a Parastomal Hernia with a Prosthetic Mesh in Patients Undergoing Permanent End-Colostomy; the PREVENT-Trial: Study Protocol for a Multicenter Randomized Controlled Trial. Trials, 13, Article No. 226. [Google Scholar] [CrossRef] [PubMed]
[23] Stabilini, C., Muysoms, F.E., Tzanis, A.A., Rossi, L., Koutsiouroumpa, O., Mavridis, D., et al. (2023) EHS Rapid Guideline: Evidence-Informed European Recommendations on Parastomal Hernia Prevention—With ESCP and EAES Participation. Journal of Abdominal Wall Surgery, 2, Article No. 11549. [Google Scholar] [CrossRef] [PubMed]
[24] Ferrara, F., Parini, D., Bondurri, A., Veltri, M., Barbierato, M., Pata, F., et al. (2019) Italian Guidelines for the Surgical Management of Enteral Stomas in Adults. Techniques in Coloproctology, 23, 1037-1056. [Google Scholar] [CrossRef] [PubMed]
[25] Hendren, S., Hammond, K., Glasgow, S.C., Perry, W.B., Buie, W.D., Steele, S.R., et al. (2015) Clinical Practice Guidelines for Ostomy Surgery. Diseases of the Colon & Rectum, 58, 375-387. [Google Scholar] [CrossRef] [PubMed]
[26] Verdaguer-Tremolosa, M., Garcia-Alamino, J.M., Rodrigues-Gonçalves, V., Martínez-López, M.P. and López-Cano, M. (2024) Prophylactic Mesh Does Not Prevent Parastomal Hernia in Long-Term: Meta-Analysis and Trial Sequential Analysis. Surgery, 175, 441-450. [Google Scholar] [CrossRef] [PubMed]
[27] Prudhomme, M., Fabbro-Peray, P., Rullier, E., Occean, B.V. and Bertrand, M.M. (2020) Meta-Analysis and Systematic Review of the Use of a Prosthetic Mesh for Prevention of Parastomal Hernia. Annals of Surgery, 274, 20-28. [Google Scholar] [CrossRef] [PubMed]
[28] Paasch, C., Kobelt, E., Lünse, S., Heisler, S., Lorenz, R., Hunger, R., et al. (2023) How Often Is Prophylactic Parastomal Mesh Placement Performed after Rectal Resection without Sphincter Preservation? An Analysis of German Nationwide Hospital Discharge Data among 41,697 Patients. Hernia, 28, 9-15. [Google Scholar] [CrossRef] [PubMed]
[29] Aslam, M.I., Rubio-Perez, I., Smart, N.J. and Singh, B. (2019) A Survey on Practices for Parastomal Hernia Prevention and Repair among ESCP Surgeons. Hernia, 23, 825-828. [Google Scholar] [CrossRef] [PubMed]
[30] Byers, J.M., Steinberg, J.B. and Postier, R.G. (1992) Repair of Parastomal Hernias Using Polypropylene Mesh. Archives of Surgery, 127, 1246-1247. [Google Scholar] [CrossRef] [PubMed]
[31] Slater, N.J., Hansson, B.M.E., Buyne, O.R., Hendriks, T. and Bleichrodt, R.P. (2011) Repair of Parastomal Hernias with Biologic Grafts: A Systematic Review. Journal of Gastrointestinal Surgery, 15, 1252-1258. [Google Scholar] [CrossRef] [PubMed]
[32] Meng, C., Wei, Q., Sun, L., Zhang, X., Liu, Y., Gao, J., et al. (2024) Effects of Different Mesh Materials on Complications after Prophylactic Placement for Stoma Formation: A Systematic Review and Network Meta-analysis. Hernia, 28, 1039-1052. [Google Scholar] [CrossRef] [PubMed]
[33] Patrick Sames, C. (1958) Extraperitoneal Colostomy. The Lancet, 271, 567-568. [Google Scholar] [CrossRef] [PubMed]
[34] Davis, B.R., Valente, M.A., Goldberg, J.E., Lightner, A.L., Feingold, D.L. and Paquette, I.M. (2022) The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for Ostomy Surgery. Diseases of the Colon & Rectum, 65, 1173-1190. [Google Scholar] [CrossRef] [PubMed]
[35] Luo, J., Singh, D., Zhang, F., Yang, X., Zha, X., Jiang, H., et al. (2022) Comparison of the Extraperitoneal and Transperitoneal Routes for Permanent Colostomy: A Meta-Analysis with RCTs and Systematic Review. World Journal of Surgical Oncology, 20, Article No. 82. [Google Scholar] [CrossRef] [PubMed]
[36] Lian, L., Wu, X.R., He, X.S., Zou, Y., Wu, X., Lan, P., et al. (2011) Extraperitoneal vs. Intraperitoneal Route for Permanent Colostomy: A Meta-Analysis of 1,071 Patients. International Journal of Colorectal Disease, 27, 59-64. [Google Scholar] [CrossRef] [PubMed]
[37] Marks, C.G. and Ritchie, J.K. (1975) The Complications of Synchronous Combined Excision for Adenocarcinoma of the Rectum at St Mark’s Hospital. Journal of British Surgery, 62, 901-905. [Google Scholar] [CrossRef] [PubMed]
[38] Williams, J.G., Etherington, R., Hayward, M.W.J. and Hughes, L.E. (1990) Paraileostomy Hernia: A Clinical and Radiological Study. Journal of British Surgery, 77, 1355-1357. [Google Scholar] [CrossRef] [PubMed]
[39] Zhang, T., Yang, D., Sun, G. and Zhang, D. (2021) Modified Technique of Extraperitoneal Colostomy without Incision of the Posterior Rectus Sheath. Scientific Reports, 11, Article No. 2857. [Google Scholar] [CrossRef] [PubMed]
[40] Seyfried, S., Lucas, V., Galata, C., Reißfelder, C., Weiß, C., Kienle, P., et al. (2019) Incisional Hernia Rate after Ileostomy Closure in Lateral Pararectal Stoma versus Transrectal Stoma Placement: Follow‐Up of the Randomized PATRASTOM Trial. Colorectal Disease, 22, 445-451. [Google Scholar] [CrossRef] [PubMed]
[41] Zhang, X., Li, X., Cheng, Z., Wang, K., Dai, Y. and Wang, Y. (2023) Modified Approach for Extraperitoneal Colostomy Creation in Laparoscopic Abdominoperineal Resection. Diseases of the Colon & Rectum, 67, 333-338. [Google Scholar] [CrossRef] [PubMed]
[42] Li, Z., Tian, L., Liu, R., Zheng, B., Wang, B., Zhao, X., et al. (2022) A Technique for Laparoscopic Extraperitoneal Colostomy with an Intact Posterior Sheath of Rectus. BMC Surgery, 22, Article No. 239. [Google Scholar] [CrossRef] [PubMed]