乙状结肠单腔造口的不同术式及其并发症

Procedures and complications of sig moidostomy

目的探讨乙状结肠单腔造口的最佳术式,从而减少相关的并发症发生。方法总结分析本院1980～2000年间随访18个月以上的乙状结肠单腔造口1935例临床资料并进行文献复习。结果1935例中,经腹膜腹直肌旁乳头型造口(A组)547例,腹膜外隧道腹直肌旁乳头型造口(B组)556例,腹膜外隧道经腹直肌平脐平坦型造口(C组)832例。3组发生1种或1种以上并发症的发生率分别是A组47.3%、B组37.1%、C组7.6%,组间差异有显著性意义,P<0.05。B组低于A组,C组最低。结论通过腹膜外隧道经腹直肌平脐平坦型造口可有效减少造口并发症的发生率。

Objective To explore the best procedure of sigm oidostomy to reduce the related complications.Methods Data of 1935sigmoidostomy cases with a follow-up period of 18months during1980～2000were analyzed.Complications of different sigmoidostomy pro cedures were compared and literatures were reviewed.Results Among 1935sigmoidostomy cases,547cases received the procedure of through peritoneal para-abdominal rectus muscle papillary sigmoidostomy (group A),556cases extraperitoneal para-abdominal rectus muscle papillary sigmoidostomy (group B ),and 832cases extraperitoneal plan e sigmoidostomy through abdominal re ctus muscle at umbilicus level(group C).The complications were stoma ischemic necrosis in 2.6%,1.3%and 0.4%,stoma infection in 2.9%,3.1%an d 2.6%,stoma stricture in 2.2%,3.2%and 0.6%,para-stoma sk in infection in 33.6%,19.2%and 4.7%,stoma mucosa infection in 39.9%,34.7%and 0.5%,s toma mucosa prolapse in 36.8%,1.6%a nd 0.2%,para-stoma hernia in 10.2%,3.1%and 0.1%of different sigmoidostomy procedures(group A,B and C ).Conclusion Sigmoidostomy through extraperito neal tunnel,plane and through abdom inal rectus muscle at umbilicus level is the best procedure and can reduce t he related complications of sigmoid ostomy.