摘要
作为结直肠吻合口的预防性造口,袢式回肠造口与横结肠造口均可有效地转流粪便,减少吻合口漏所带来的危害,适用于具有高吻合口漏风险的低位、超低位直肠癌切除患者,特别是接受新辅助治疗者。两种造口各有利弊。本文总结了关于这两种造口的大部分对照研究,结果显示袢式横结肠造口术后的并发症率相对较高,主要包括造口脱垂、旁疝、伤口感染、还纳术后切口疝等。袢式回肠造口的主要缺点是造口高排便量、脱水以及术后肠梗阻风险。另一方面,由于部位等原因,袢式横结肠造口可以更为有效地进行结直肠减压,更适用于无法进行肠道准备如急诊手术等情况。通过手术技术的改进,或可有效地减少造口脱垂等并发症,充分发挥袢式横结肠造口的优势。
As the protective stomas for prophylactic colorectal anastomoses,both loop ileostomy and loop transverse colostomy can be used to effectively divert stool thus mitigate the negative consequences of anastomotic leakage.These two methods are appropriate for defunctioning the low or ultra-low anastomosis after resection of the low rectal cancer,a condition bearing high risk of anastomotic leak,especially after neoadjuvant radiochemotherapy.Each method of defunctioning has its advantages and disadvantages.In this article,the results of most current contrast studies comparing these two stoma procedures is summarized.The results suggest that loop transverse colostomy is associated with a higher rate of postoperative complications,including prolapse,parastomal hernia,wound infection,and incisional hernia after reversal.The principal disadvantages of loop colostomy include high stoma output,dehydration,and the risk of postoperative bowel obstruction.Besides,loop transverse colostomy is thought to work more efficiently in decompressing the large bowel due to its location.So it is more preferable during the emergency surgery without sufficient bowel preparations.With the improvement of surgical procedures,loop transverse colostomy may be performed with fewer complications such as collapse and give full play to its advantages.
出处
《中国现代手术学杂志》
2011年第1期65-68,共4页
Chinese Journal of Modern Operative Surgery
