经腹直肌隧道式腹膜外结肠造口预防Miles术后造口旁疝的临床价值

目的探讨经腹直肌隧道式腹膜外结肠造口预防直肠癌Miles术后造口旁疝的临床价值。方法回顾性分析2008年1月至2014年12月,中山大学附属佛山医院和中山大学附属第一医院两家医院207例行Miles术的直肠癌患者临床资料,其中腹腔镜手术98例,开腹手术109例;经腹直肌隧道式腹膜外结肠造口(腹膜外组)79例,预置补片腹膜内结肠造口(预置补片组)36例,腹膜内结肠造口(腹膜内组)92例。观察其各种造口并发症的发生率及术后半年患者造口排便情况。结果各组中发生造口缺血坏死、狭窄、回缩、皮肤黏膜分离、黏膜脱垂、肠梗阻的情况相比较,差异无统计学意义(P0.05)。腹膜外组1例(1.27%)发生造口旁疝,预置补片组未发生造口旁疝,腹膜内组15例(16.30%)发生造口旁疝;腹膜外组和预置补片组造口旁疝发生率均明显低于腹膜内组(P0.05)。半年后造口排便功能,腹膜外组(1~4)次/d,预置补片组(5~6)次/d,腹膜内组(5~7)次/d,腹膜外组造口功能明显好于预置补片组和腹膜内组。结论经腹直肌隧道式腹膜外结肠造口可较好的预防直肠癌Miles术后造口旁疝的发生。     

直肠癌Miles术中造口方法的临床研究

目的　评价腹膜外结肠造口并一期开放在直肠癌Miles术中的临床应用价值。　方法　回顾性分析研究 2 18例直肠癌Miles手术的临床资料 ,其中 150例 (治疗组 )行腹膜外结肠造口并一期开放术 ,68例 (对照组 )行传统的腹膜内结肠造口分期开放术。　结果　所有病例经 2年以上的随访 ,治疗组有 4例出现造口周围皮肤炎 ,1例发生造口旁疝 ,并发症发生率为 3 .3 3 % ,55例病人获排便感觉。对照组造口并发症发生率为 3 3 .8% ,其中造口周围皮肤感染 1.47% (1例 ) ,造口回缩 4.41% (3例 ) ,造口狭窄 14 .71% (10例 ) ,腹腔内疝 4.41% (3例 ) ,造口旁疝 4.41% (3例 ) ,造口脱垂 4.41% (3例 ) ;无一例病人有排便感。两组在并发症发生率及排便感觉上有显著性差异 (P <0 .0 1)。　结论　Miles手术时采用腹膜外结肠造口并一期开放术 ,较传统术式并发症少 ,术后管理容易 ,排便功能好     

直肠癌Miles术中行腹膜外结肠造口的临床应用价值

为探讨腹膜外结肠造口在直肠癌Miles术中的临床应用价值,回顾直肠癌Miles术中行腹膜外结肠造口者（治疗组,20例）和腹膜内结肠造口者（对照组,20例）资料,就造口并发症的发生率进行对比分析。结果显示,术后随访6～12个月,治疗组造口感染1例,其余造口愈合良好,无其他并发症;对照组造口感染1例,造口回缩2例,腹腔内疝1例,造口旁疝5例,造口狭窄1例,肠梗阻1例。治疗组造口并发症发生率（5．0％）明显低于对照组（55．0％）,P〈0．01。结果表明,与腹膜内结肠造口相比,直肠癌Miles术中行腹膜外结肠造口术后并发症更少,具有较高的临床应用价值。     

腹会阴联合切除术两种乙状结肠造口对比分析

目的比较腹会阴联合切除术患者经腹膜内、外两种乙状结肠造口的临床结果。方法回顾性分析2010年3月至2014年3月期间内江市第二人民医院普外科172例行腹会阴联合切除术患者的临床资料。其中经腹膜内乙状结肠造口60例(经腹膜内组)、经腹膜外乙状结肠造口76例(经腹膜外组)及经腹膜外乙状结肠造口并功能锻炼36例(功能锻炼组)。对比3组患者的手术情况、术后并发症发生情况及造口功能。结果 1手术情况:3组患者在造口定位选择、手术时间、术中出血量及术后住院时间方面比较差异无统计学意义(P0.05);经腹膜内组和功能锻炼组在术后首次排气和排便时间明显早于经腹膜外组,差异具有统计学意义(P0.05)。2术后并发症:经腹膜外组和功能锻炼组的造口并发症发生率低于经腹膜内组,差异具有统计学意义(P0.05);功能锻炼组又低于经腹膜外组,差异也具有统计学意义(P0.05)。3造口功能:经腹膜外组排便信号出现时间30 s者所占比例明显高于经腹膜内组,功能锻炼组又高于经腹膜外组,差异均具有统计学意义(P0.05);经腹膜外组排便信号出现后自主控制排便到排出粪便时间2 min者所占比例明显高于经腹膜内组,功能锻炼组又高于经腹膜外组,差异均具有统计学意义(P0.05)。结论腹会阴联合切除术经腹膜外乙状结肠造口较经腹膜内造口术后造口相关并发症少,且控便、排便能力更好。术后功能锻炼能进一步减少造口相关并发症及改善造口功能。     

低位直肠癌腹腔镜腹会阴切除术经腹膜外隧道径路造口的疗效观察

目的：评价腹腔镜低位直肠癌腹膜内与腹膜外两种结肠造口方式的临床疗效。方法：回顾分析2009年1月至2012年1月为68例患者行腹腔镜直肠癌腹会阴切除术（abdominoperinealreseetion,APR）的临床资料,其中55例经腹膜外隧道径路行结肠造口（观察组）,13例经腹膜内行结肠造12（对照组）,对比分析两种造12：7方式的安全性、相关并发症及造12功能的恢复情况。结果：术后患者均获随访,随访3～50个月,中位随访期24个月。观察组术后发生造口相关并发症5例（9．09％）,术后6个月造12功能临床优良率为63．6％;对照组术后发生造口相关并发症4例（30．8％）,术后6个月造口功能临床优良率为30．8％。观察组结肠造口功能明显优于对照组。两组均无中转开腹及手术死亡病例。结论：腹腔镜APR经腹膜外隧道径路行结肠造口操作简单,可有效减少造口相关并发症的发生,提高患者生活质量,是理想术式。     

腹腔镜ELAPE术中乙状结肠腹膜外隧道造口的临床效果观察

评价腹腔镜下经括约肌外直肠癌根治术(ELAPE术)中乙状结肠腹膜外隧道造口的临床应用效果。将行腹腔镜ELAPE术的80例低位直肠癌患者分为两组,实验组40例行乙状结肠腹膜外隧道造口,对照组40例行传统腹膜内乙状结肠造口术。比较两组造口并发症和排便功能。随访3~24个月,平均13.5个月。实验组发生早期排便困难4例,1个月后症状缓解;无其他并发症。实验组并发症发生率为10%,36例获得排便感(90%)。对照组发生造口旁疝5例,结肠脱垂3例,造口回缩3例,造口狭窄3例,腹内疝1例,早期排便困难2例;并发症发生率42.5%,12例获得排便感觉(30%)。两组比较差异有统计学意义(P0.05)。腹腔镜ELAPE术乙状结肠腹膜外隧道造口术后并发症发生率低,控便功能好,可明显提高患者术后生存质量。     

腹腔镜Miles术中两种结肠造口方式的疗效报告

目的 评价腹腔镜Miles术中腹膜内及腹膜外隧道式乙状结肠造口的临床应用效果.方法 腹腔镜Miles手术32例,其中14例行腹膜外隧道式造口,18例行腹膜内造口,比较两种造口方式并发症发生率及排便功能.结果 行腹膜外隧道式乙状结肠造口术14例中,发生造口狭窄1例(7.1%),获排便感12例(85.7%);腹膜内造口术18例中,发生造口狭窄1例、造口旁疝2例、肠脱垂2例,并发症发生率为 27.8%(5/18),获排便感6例(33.3%).行腹膜外隧道式乙状结肠造口术与肠造口有关的并发症发生率与行腹膜内造口术比较,差异无统计学意义(χ2=2.201,P=0.138).术后患者获排便感前者明显高于后者,两者比较差异有统计学意义(χ2=8.780,P=0.003).结论 腹膜外乙状结肠造口在腹腔镜辅助的Miles术中操作难度不大,具有排便控制功能较好的优点,可提高患者的生存质量,值得在临床推广.     

腹腔镜下腹会阴直肠癌手术中两种乙状结肠造口的临床比较

目的对比腹腔镜下腹会阴直肠癌手术中两种乙状结肠造口的临床效果。方法回顾性队列研究2017年5月至2020年3月在接受腹腔镜下腹会阴直肠癌手术的81例患者临床资料,根据术中乙状结肠造口方式不同分为腹膜外组(经腹膜外造口,36例)、腹膜内组(经腹膜内造口,45例),采用SPSS23.0软件进行处理,围术期指标等以■表示,独立t检验;排便功能、Kirwan失禁分级、术后并发症等用χ~2检验或秩和检验,P0.05为差异有统计学意义。结果腹膜外组手术时间、术后首次排气、排便时间、术后住院时间和术中出血量均少于腹膜内组(P0.05);腹膜外组术后排便功能总优良率(80.6%)比腹膜内组(60.0%)高(P0.05)、术后Kirwan失禁分级比腹膜内组轻(P0.05);腹膜外组术后并发症发生率(8.3%)比腹膜内组(26.7%)低(P0.05)。结论相比经腹膜内乙状结肠造口,腹腔镜下腹会阴直肠癌手术中经腹膜外造口更利于加快术后康复进程,减少造口并发症,且患者排便、控便能力更好,安全性更高。     

乙状结肠造口方法的选择(摘要)

直肠癌患者行手术治疗时,大部分须行永久性乙状结肠造口,而乙状结肠造口并发症发生率高达11%~30%。选择恰当的造口方法可以减少并发症的发生．作者在1995~1997年作乙状结肠造口52例中,经腹腔造口20例,并发症3例(3/20),结肠末端襻式造口4例,并发症1例(1/4),腹膜外结肠造口28例,无并发症(0/28)。认为;腹膜外结肠造口术并发症少,手术操作亦不复杂,只要条件允许应作为首选方法。而急症行直肠癌根治术或造口肠管及系膜较短,为避免因系膜张力过大而发生并发症,宜选用经腹腔结肠造口或结肠末端襻式造口术。     

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目的　探讨乙状结肠腹膜外造口一期乳头成形在Miles术中应用的临床效果。方法　将接受Miles手术的 186例病人分为两组 ,实验组 92例施行乙状结肠腹膜外造口一期乳头成形术 ,对照组 94例行传统的腹膜内结肠造口术 ,比较两组病人的造口并发症和排便功能改善情况。结果　实验组 92例病人中的 75例经过 3～60个月的随访 ,有 2例发生造口狭窄 ,并发症发生率为 2 7% ,62例病人获排便感 (占 82 7% )。对照组 94例中的 78例经过 3～ 60个月的随访 ,发生造口段肠缺血坏死 2例 ,肠脱垂 3例 ,腹内疝 2例 ,造口回缩 3例 ,造口处切口疝 2例 ,造口狭窄 6例 ,各种并发症的发生率为 2 3 1% ,2 1例病人有排便感 (占 2 6 9% ) ,两组比较差异均有显著性 (P <0 0 5 ) ,实验组与肠造口有关的并发症明显低于对照组 ,而其术后所获排便感明显高于后者。结论　乙状结肠腹膜外造口一期乳头成形术具有术后并发症发生率低和排便功能恢复好的优点 ,可提高病人术后的生活质量 ,值得在临床上推广应用     

永久性乙状结肠造口的手术方法及并发症的防治

目的 探讨永久性乙状结肠造口的手术细节及其并发症的防治要点。方法 总结1997-1999年间152例行永久性乙状结肠造口的直肠肛管癌患的造口手术操作要点和近期并发症的发生情况，分析并发症发生的原因及防治对策。结果 所有患的造口手术均按统一规范进行，早期并发症发生率较低，主要有水肿(7．9％，12／152)、缺血(1．3％，2／152)和延迟排气(2．6％，4／152)。无严重并发症出现。结论 规范的手术可使永久性乙状结肠造口手术的并发症发生率明显降低，其要点是合适的术前定位、精心细致的手术操作、良好的血液供应和防止感染。     

Evaluation of the end colostomy complications and the risk factors influencing them in Iranian patients

INTRODUCTION: The aim of this study was to assess the prevalence of end colostomy complications and the evaluation of factors influencing outcome. PATIENTS AND METHODS: Three hundred and thirty patients with end colostomy were studied. All patient were recalled for examination for recent complications. Early complications included stoma site pain, early dermal irritation (during the first month after surgery), mucosal bleeding, stomal prolapse and psychosocial complications. Late complications included peristomal hernia, stomal stenosis, late dermal irritation (after the first month), stomal retraction, stomal necrosis and other stoma complications (perforation, fistula etc.). Probable underlying factors were studied. To evaluate risk factors affecting complications, univariable analysis and then multivariable analysis by binary logistic regression was performed. RESULTS: One hundred and one (30.6%) patients had no complications and the remainder had at least one of early or late complications. Overall, psychosocial complications, 56.4%; mucosal bleeding, 34.5%; early dermal irritation, 23.5% were the most frequent complications. Peristomal hernia (11.2%) was the most common late complication. Those aged > 40 years had significant associations with psychosocial problem (OR = 2.77), mucosal haemorrhage (OR = 2.19), and early dermal irritation (OR = 3.14). The risks of peristomal hernia and early dermal irritation are greater in the patients with BMI > 25 kg/m2 (OR = 2.08 and 2.55, respectively). CONCLUSION: The risk of most prevalent complications of colostomy construction increases in elder patients. The high prevalence of psychosocial and skin problems in patients with a colostomy, needs special attention especially from the viewpoint of education by trained stoma nurses and preparation of standard equipment.     

直肠癌腹壁造瘘口并发症的防治：附299例报告

目的探讨直肠癌腹壁造瘘口并发症的原因及防治措施。方法回顾性分析直肠癌腹壁造瘘手术299例患者临床资料,观察造瘘口并发症的情况。结果造瘘口并发症发生率33.1%(99/299),其中造瘘口周围皮炎91例(30.4%),造瘘口狭窄8例(2.7%),造瘘口梗阻3例(1.0%),造瘘口脱垂17例(5.7%),造瘘口坏死2例(0.6%);端式造瘘组219例,其造瘘口周围皮炎、造瘘口脱垂的发生率明显低于袢式造瘘组(80例)(P0.01);在端式造瘘组中,经腹膜外途径造瘘者(213例)其造瘘口梗阻及造瘘口旁疝的发生率又较经腹膜内途径造瘘者(6例)为低。结论术中对造瘘相关因素的及时处理及造瘘术式的合理选择有助于减少造瘘口并发症的发生。     

Colostomy complications in infants and children.

Seventy-seven colostomies were performed in 74 patients: 35 for high anorectal agenesis, 34 for Hirschsprung's disease, 2 for necrotizing enterocolitis, 2 for small left colon syndrome, and 1 for volvulus neonatorum with perforation. There were 55 boys and 19 girls with a mean age of 0.8 years. The different types of colostomies performed were: transverse loop in 48, sigmoid loop in 21, transverse end in 4, descending end in 2, sigmoid end in 1, and transverse double barrel in 1. Forty-seven patients developed stomal complications (74.6%). Eleven patients died, but only in 2 (2.7%) were the deaths directly related to colostomy formation. Five patients required stomal revision (6.8%). The incidence of complications was neither related to the age nor to the primary indication for the colostomy, but sigmoid colostomy was associated with a lower complication rate compared to transverse colostomy (52% versus 81% 0.02 greater than p greater than 0.01). A sigmoid loop colostomy should be used whenever possible.     

Incontinent urinary diversion]

We analyzed 237 patients who underwent total cystectomy with ileal conduit urinary diversion or cutaneous ureterostomy at the Center for Adult Diseases, Osaka. One-hundred and eighty-eight patients underwent ileal conduit diversion and 49 patients underwent cutaneous ureterostomy. No patient died within 30 days after the operation, but two patients who underwent ileal conduit diversion died of postoperative complications within 2 months. Early complications occurred in 94 patients (50%) in the ileal conduit group and in 18 patients (37%) in the ureterostomy group. Late complications occurred in 85 patients (45%) in the ileal conduit group and in 23 patients (47%) in the ureterostomy group. Frequent early complications in the ileal conduit group were wound infection (29%), and intestinal complications (13%) which included ileus and upper urinary tract complications (12%). The most frequent late complications were stomal complications (26%) which included peristomal dermatitis stomal stenosis, parastomal hernia, and stomal prolapse, and upper urinary tract complications which were noted in 27 patients (14%).     

腹腔镜下腹会阴切除术两种结肠造口方式的比较

目的探讨腹腔镜下腹会阴切除术（LAPR）乙状结肠单腔造口的手术方式，以减少造口并发症的发生。方法63例患者中，低位直肠癌53例，直肠肛管癌10例。有61例用圆形吻合器行乙状结肠与腹壁皮肤吻合造口，2例手工缝合乙状结肠造口。腹腔内腹直肌型结肠造口37例（A组）；腹膜外隧道腹直肌型结肠造口26例（B组）。结果全组在腹腔镜下完成降结肠、乙状结肠和直肠的分离以及会阴部的直肠肛门开放性切除。无中转开腹，无手术死亡。两组的平均手术时间差异无统计学意义（P〉0．05）；而术后人工肛门排气时间[A组（2．4±1．1）d与B组（1．9±0．8）d比较，P〈0．05]、术后平均住院日[A组（19．9±7．8）d与B组（14．5±3．9）d比较，P〈0．01]及造口相关并发症的发生率（A组29．4％，B组4．0％；两组比较P〈0．05）差异均有统计学意义；B组患者术后平均住院日较A组短，造口相关并发症低于A组。结论LAPR手术中。采用圆形吻合器经腹膜外隧道和腹直肌行乙状结肠单腔造口，可有效地减少造口并发症的发生和缩短手术后的住院时间。     

Revision and closure of the colostomy

Reoperative stomal surgery includes the correction of complications and closure of a colostomy. Necrosis, retraction, and stenosis are the most frequently occurring complications and are simply corrected by straightforward techniques. Prolapse of the colostomy and parastomal hernia occur less frequently. Their repair is slightly more complex than that of the previous group of complications. Colostomy closure ranges from simple suture closure of the loop colostomy, through anastomosis of the divided colostomy, to the sometimes difficult gastrointestinal reconstruction after the Hartmann procedure. Death after closure of colostomy is infrequent, but anastomotic complications occur after all types of closure. Leak and sepsis are by far the most frequent anastomotic complications. Stenosis occurs less often. The same degree of care exercised during colectomy and anastomosis is necessary for optimal results after colostomy closure.     

直肠癌Miles术后结肠造口的临床研究

目的探讨直肠癌Miles术后结肠造口并发症特点、预防和处理。方法回顾性分析我院1998年1月至2008年1月收治300例直肠癌Miles术后结肠造口的临床资料，分析结肠造口并发症的特点及防治措施。结果结肠造口术后并发症发生率18．0％（54／300），其中造口缺血坏死2．66％（8／300），造口旁疝1％（3／300），腹腔内疝2．33％（7／300），造口周围炎4．67％（14／300），造口狭窄3．33％（10／300），造口回缩4％（12／300）。年龄超过60岁的患者造口并发症发生率明显提高，造口缺血与腹壁外段造口肠管的长度、造口开放方式有关，造口狭窄与腹壁切口直径、造口开放方式有关，造口旁疝和脱垂与患者体形有关。结论结肠造口并发症发生率与手术方式、患者年龄和体形有密切关系，根据个体情况，选择合理的造口类型和构造，可减少并发症发生率。术中应避免造口段肠管张力过大，肠系膜离断过多，实行一期黏膜皮肤缝合开放造口。