大肠癌患者结肠造口并发症的治疗及预防

目的 探讨大肠癌患者结肠造口术后并发症的治疗及其预防措施。方法 回顾性分析82例结肠造口的大肠癌患者的临床资料。所研究的肠造口并发症包括周围皮肤炎症、缺血坏死、出血、皮肤黏膜分离、感染、造口回缩、造口狭窄及造口脱出。结果 结肠造口并发症发生24例,占全部病例的29.27%。造口坏死、造口回缩或者狭窄、感染等肠造口并发症的发生率急诊手术高于择期手术(χ²=8.2,P＜0.05)。手术方式的选择及手术操作技术影响造口并发症的发生。发生肠造口并发症的患者在围手术期内生活质量减低(t=3.325,P＜0.05)。本组研究病例无肠造口并发症相关死亡病例。结论 充分的术前准备,合理的手术方式的选择,规范仔细的手术操作,术后积极的治疗,及时的观察和正确的护理,是防治大肠癌结肠造口并发症的关键。避免肠造口并发症的发生有利于改善患者的生活质量。

The prevention and treatment of complications of colostomy with carcinoma of large intestine

Objective To study the prevention and treatment of complications of colostomy with carcinoma of large intestine. Methods 82 colostomies with carcinoma of large intestine were reviewed. The incidence and method of treatment of peristomal dermatitis, stomal necrosis, stomal hemorrhage, disassociation of skin and mucosa,infection,stomal retraction,stomal stenosis and prolapse of the stomal were analyzed. Results All stomal complications occurred in 24 patients（29.27% ）. The occurrence rates of partial necrosis,retraction and stenosis were higher in emergency operations than those in seleclive operations（ χ^2 = 8.2, P 〈 0.05 ）. The complications of colostomy were mainly due to technical factors and could he prevented. The GOL（ quality of lite）of the patients with colostomy complications was depressed （ t = 3. 325,P 〈 0. 05 ）. There were no death patients v, ith the complications of colostomy in this group. Conclusions Sufficient preoperative intestinal preparation, rational chosing operative modality,location of colostomy and operative instruments properly selected, careful operative performation and postoperative treatment are the key points to avoid the complication and improve the life quality of the patients with carcinoma of large intestine.