asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/akh2024-022asurgery-485Research ArticleОБМЕН ОПЫТОМEXCHANGE OF EXPERIENCE | PRACTICEПарастомальные грыжи: состояние проблемы, возможности профилактики и лечения на госпитальном и амбулаторном этапахParastomal hernias: the state of the problem, the possibilities of prevention and treatment at the hospital and outpatient stageshttps://orcid.org/0000-0001-7473-6692КаторкинС. Е.KatorkinS. E.

Каторкин Сергей Евгеньевич, д.м.н., профессор, заведующий кафедрой и клиникой госпитальной хирургии 

443099, Россия, Самара, ул. Чапаевская, д. 89 

Sergei E. Katorkin, Dr. Sci. (Med.), Professor, Head of the Department and Clinic of Hospital Surgery

89, Chapaevskaya St., Samara, 443089, Russia 

katorkinse@mail.ruhttps://orcid.org/0009-0006-8143-651XКуперВ. Д.KuperV. D.

Купер Василиса Дмитриевна, врач-колопроктолог, старший лаборант кафедры госпитальной хирургии 

443099, Россия, Самара, ул. Чапаевская, д. 89 

Vasilisa D. Kuper, Coloproctologist, Senior Assistant of the Department of Hospital Surgery 

89, Chapaevskaya St., Samara, 443089, Russia 

vkuper@list.ruhttps://orcid.org/0000-0002-4817-3360ЛичманЛ. А.LichmanL. L.

Личман Леонид Андреевич, к.м.н., доцент кафедры госпитальной хирургии 

443099, Россия, Самара, ул. Чапаевская, д. 89 

Leonid L. Lichman, Cand. Sci. (Med.), Coloproctologist, Associate Professor of the Department of Hospital Surgery 

89, Chapaevskaya St., Samara, 443089, Russia 

lichman163@gmail.comhttps://orcid.org/0000-0002-0264-7305АндреевП. С.AndreevP. S.

Андреев Павел Сергеевич, к.м.н., заведующий колопроктологическим отделением клиники госпитальной хирургии, доцент кафедрыгоспитальной хирургии 

443099, Россия, Самара, ул. Чапаевская, д. 89 

Pavel S. Andreev, Cand. Sci. (Med.), Head of the Department of Colorectal Surgery, Clinic of Hospital Surgery, Associate Professor of the Department of Hospital Surgery 

89, Chapaevskaya St., Samara, 443089, Russia 

pashaandreev@yandex.ruСамарский государственный медицинский университетРоссияSamara State Medical UniversityRussian Federation202420112024212216228Copyright © Каторкин С.Е., Купер В.Д., Личман Л.А., Андреев П.С., 20242024Каторкин С.Е., Купер В.Д., Личман Л.А., Андреев П.С.Katorkin S.E., Kuper V.D., Lichman L.L., Andreev P.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.a-surgeon.ru/jour/article/view/485

По данным Всемирной организации здравоохранения, ежегодно наблюдается рост количества пациентов с кишечными стомами, численность которых составляет 100–150 чел. на 100 000 населения. В Самарской области Российской Федерации на 2019 г. проживало более 3000 стомированных пациентов. Это приводит к увеличению факторов риска развития осложнений, из которых наиболее распространенным является формирование парастомальных грыж, которые спустя два года и более диагностируются не менее чем у 50% стомированных пациентов и приводят к выраженному ухудшению качества жизни. Целью данного обзора является анализ современного определения понятия парастомальной грыжи, эпидемиологии, факторов риска, существующих классификаций, методов диагностики, консервативного и хирургического лечения, а также профилактики парастомальных грыж. В настоящее время специфические методы консервативного лечения парастомальных грыж отсутствуют. Современные хирургические методы лечения пациентов с парастомальными грыжами можно разделить на три группы: транспозиция стомы, аутогерниопластика и аллогерниопластика. Но единый алгоритм выбора их хирургической коррекции отсутствует. Поэтому разработка новых методов лечения, а также модификаций уже существующих продолжает оставаться актуальной. При анализе возможных путей профилактики развития парастомальной грыжи установлена важность акцентированного внимания на этой проблеме на всех этапах медицинской реабилитации. Во время предоперационной подготовки важно правильно выбрать местоположение будущей стомы, а также определиться с доступом вмешательства. Интраоперационно необходимо адекватно подойти к выбору способа выведения и соблюдать принципы формирования кишечных стом, а также использовать сетчатый имплантат. В раннем послеоперационном периоде важно в доступной форме донести до пациента информацию о необходимости и правилах ношения бандажа, а также обучить пациента самостоятельному уходу за стомой. Необходимо увеличить количество специализированных кабинетов для стомированных пациентов и расширить возможности телемедицинских технологий для повышения доступности помощи на амбулаторном этапе.

According to WHO there is an annual increase in the number of ostomy patients, whose number is 100–150 people per 100,000 population. As of 2019, there were more than 3,000 ostomy patients living in the Samara region of the Russian Federation. This leads to an increase in risk factors for complications, the most common of which is the formation of parastomal hernias. After two years or more, parastomal hernias are diagnosed in at least 50% of stomached patients andlead to a marked deterioration in the quality of life. The purpose of this review is to analyze the modern definition of the concept of parastomal hernia, epidemiology, risk factors, existing classifications, diagnostic methods, conservative and surgical treatment, as well as prevention of parastomal hernia. Currently there are no specific methods for the conservative treatment of parastomic hernias. Modern surgical methods for treating ostomy patients can be divided into three groups: stoma transposition, autogernioplasty and allogernioplasty. But there is no single choice of an algorithm for their surgical correction. Therefore, the development of new treatment methods, as well as modifications of existing ones, continues to be relevant. In the analysis of possible ways to prevent the development of parastomal hernia, the importance of focusing on this problem at all stages of medical rehabilitation has been established. During the pre-operative preparation, it is important to choose the correct location of the future stoma, as well as to determine the access to the intervention. It is necessary to appropriately approach the choice of the method of elimination and observe the principles of intestinal stoma formation, as well as to use a mesh implant. It is important to provide detailed information to the patient in the early postoperative period and to develop the number of specialized offices for stoma patients.

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The authors declare that there are no conflicts of interest present.