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  • Title: [A preliminary report of laparoscopic extraperitoneal colostomy anterior to posterior sheath of rectus abdominis-transversus abdominis to prevent parastomal hernia].
    Author: Li ZY, Wang B, Zheng BB, Qiu J.
    Journal: Zhonghua Wai Ke Za Zhi; 2023 Jun 01; 61(6):481-485. PubMed ID: 37088480.
    Abstract:
    Objective: To examine the preliminary effect of laparoscopic extraperitoneal colostomy anterior to posterior sheath of rectus abdominis-transversus abdominis for the prevention of parastomal hernia after abdominoperineal resection for rectal cancer. Methods: This study is a prospective case series study. From June 2021 to June 2022, patients with low rectal cancer underwent laparoscopic abdominoperineal resection combined with extraperitoneal colostomy anterior to posterior sheath of rectus abdominis-transversus abdominis at the First Department of General Surgery, Shaanxi Provincial People's Hospital were enrolled. The clinical data and postoperative CT images of patients were collected to analyze the incidence of surgical complication and parastomal hernia. Results: Totally 6 cases of patient were enrolled, including 3 males and 3 females, aging 72.5 (19.5) years (M(IQR)) (range: 55 to 79 years). The operation time was 250 (48) minutes (range: 190 to 275 minutes), the stoma operation time was 27.5 (10.7) minutes (range: 21 to 37 minutes), the bleeding volume was 30 (35) ml (range: 15 to 80 ml). All patients were cured and discharged without surgery-related complications. The follow-up time was 136 (105) days (range: 98 to 279 days). After physical examination and abdominal CT follow-up, no parastomal hernia occurred in the 6 patients up to this article. Conclusions: A method of laparoscopic extraperitoneal colostomy anterior to posterior sheath of rectus abdominis-transversus abdominis is established. Permanent stoma can be completed with this method safely. It may have a preventive effect on the occurrence of parastomal hernia, which is worthy of further study. 目的： 探讨腹腔镜腹直肌后鞘-腹横肌前腹膜外隧道乙状结肠造口术预防术后造口旁疝的初步效果。 方法： 本研究为前瞻性病例系列研究，纳入2021年6月至2022年6月因低位直肠癌在陕西省人民医院普外一科接受腹腔镜腹会阴联合直肠癌根治术及腹腔镜腹直肌后鞘-腹横肌前腹膜外乙状结肠隧道造口术的患者，收集其临床资料及术后随访资料。分析腹直肌后鞘-腹横肌前腹膜外隧道造口术的手术时间、造口时间和术后并发症，初步报告该术式预防造口旁疝的效果。 结果： 共入组6例患者，男性3例，女性3例，年龄72.5（19.5）岁［M（IQR）］（范围：55~79岁）。手术时间250（48）min（范围：190~275 min），预建造口隧道时间27.5（10.7）min（范围：21~37 min），术中出血量30（35）ml（范围：15~80 ml）。所有患者术后未发生手术相关并发症。术后随访136（105）d（范围：98~279 d），体检和腹部CT均未发现造口旁疝。 结论： 利用腹腔镜腹直肌后鞘-腹横肌前腹膜外隧道造口的方法，可较安全地完成乙状结肠永久造口，对造口旁疝的发生可能具有预防作用，值得进一步研究。.
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