结肠造口并发症的原因及防治

The Causes,Prophylaxis and Management of Complications after Colostomy

[目的]分析结肠造口并发症的原因，探讨其防治措施。[方法]回顾分析1987年至1997年10年间所作结肠造口158例，其中结直肠癌150例，结肠吻合口疾3例，肛管直肠外伤需旷置3例，结-肚吻合口瘘2例；单腔结肠造口122例，双腔结肠造口36例；急诊手术组32例，择期手术组126例。（结果）并发症共27例，发生率为17％；单腔造口为11例，双腔造口为16例；急诊手术组为10例，择期手术组为17例，前者的发生率明显高于后者。[结论]术前充分的肠道准备，合理选择造口术式、造口部位及造口器材；术中正确细心的操作；术后细致的护理及严密观察，是减少结肠造口并发症，提高结肠造口水平的重要步骤。

[Purpose] To analyze and investigate the causes and the management of the complications after colostomy. (Meth-ods] Retrospective analysis was made on 158 cases of colostomy from 1987 to 1997, including colorectal cancer in 150, colonic anastometic leakage in 2, colorectal trauma in 3 and coloanal anastomotic leakage in 2. Proxirnal colostomy and exteriorization colostomy were performed in 122 and 36 respectively, with 32 in emergency operation and 126 in selective operation. [Results] 27out of 158 cases developed complications, including 11 in proxitnal colostomy, 16 in exteriorization colostomy, 10 in emergency op-erations and 17 in selective operations. [Conclusions] Sufficiant preoperative intestinal preparation, rational chosing operativemodality. Location of colostomy and operative instruments properly selected, careful operative perforrnation and postoperativetreatment are the key points to improve the life quality and avoid the complication.