直肠癌患者Miles术后结肠造口并发症与相关因素分析

Analysis of colostomy-related complications and their relevant factorts after Miles opertion

目的探讨直肠癌患者Miles术后结肠造口并发症与相关因素。方法回顾总结1997～2010年间256例直肠癌患者Miles术后结肠造口的临床资料,分析手术情形及患者年龄、性别、体形对结肠造口并发症的影响。结果 256例结肠造口患者中,有84例出现129个并发症。并发症发生率,造口局部坏死2.3%(6/256),造口周围炎症24.6%(63/256),造口回缩狭窄4.7%(12/256),造口粘膜脱垂9.0%(23/256),造口旁疝9.8%(25/256)。末端造口通过腹膜外隧道可减少并发症的发生率;年龄超过60岁的患者,其造口并发症的发生率明显升高;体形消瘦者造口粘膜脱垂和造口旁疝的发生率明显上升,体形肥胖者造口局部坏死、造口周围炎和造口回缩狭窄的发生率明显上升。结论直肠癌患者Miles术后结肠造口的并发症与手术情形、患者年龄及体形有密切关系。根据个体情况,选择合理的造口结构,有助于减少结肠造口并发症的发生率和改善患者生活质量。

Objective To explore colostomy-related complications and their relevant factors after Miles operation. Methods colostomy after Miles operation was performed on 256 patients from 1997 to 2010.the clinical data were analyzed retrospectively including operative procedures ,individual factors such as age, gender, weight. Results 129 stomal complications occurred in 84 patients. The occurrence rate of stomal complications such as partial necrosis, tissue infection, retraction and stenosis, prolapse and peristomal hernia were 2.3%（6/256）,24.6%（63/256）,4.7%（12/256）,9.0%（23/256） and 9.8%（25/256） respectively. End-colostomy through extraperitoneal tunnel could reduce the complications, the occurrence rate of stomal complications was higher in the patients more than 60 years old. the incidences of prolapse and peristomal hernia were significantly high in emaciated patents. While those of partial necrosis, tissue infection, retraction and stenosis were significantly high in obese patients. Concusion Complica- tions of colostomy after Miles operation are related to operative procedures, stoma shapes and age. Rational configuration based on individual factors may benefit in reducing complications and improving the quality of life.