论文部分内容阅读
目的探讨Miles手术结肠造口并发症的预防和处理。方法对126例直肠癌患者结肠造口的临床资料进行回顾性分析。结果在126例结肠造口患者中,术后发生并发症28例,占22.2%。其中造口缺血1例(0.8%),造口黏膜皮肤分离2例(1.6%),造口狭窄10例(7.9%),造口回缩2例(1.6%),内疝1例(0.8%),造口旁疝1例(0.8%),造口周围炎11例(8.7%)。造口缺血与腹壁外段造口肠管长度、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;造口回缩、内疝及造口旁疝与腹壁外段造口肠管长度、造口开放方式有关。25例经保守治疗痊愈或缓解;2例造口狭窄严重者,行造口重建术后痊愈。结论为减少结肠造口并发症的发生,手术中应避免造口段肠管张力过大,肠系膜离断过多;合理选择腹壁造口直径;实行一期黏膜皮肤缝合开放造口。
Objective To investigate the prevention and treatment of the complications of colostomy in Miles operation. Methods The clinical data of colostomy in 126 patients with rectal cancer were analyzed retrospectively. Results Among the 126 patients with colostomy, 28 cases occurred postoperative complications, accounting for 22.2%. One case of ostomy (0.8%), 2 cases of ostomy mucosal skin separation (1.6%), stoma stenosis in 10 cases (7.9%), ostomy contraction in 2 cases (1.6%), internal hernia in 1 case ( 0.8%), 1 case of parastomal hernia (0.8%) and 11 cases of periostitis (8.7%). Ostomy ischemia and the length of the abdominal wall stoma intestinal length, stoma open way; stoma stenosis and abdominal wall incision diameter, stoma open way; stoma retraction, internal hernia and parastomal hernia and abdominal wall outside the segment made Mouth length, stoma open way. 25 cases were cured or relieved by conservative treatment; 2 cases with severe stoma stenosis were cured after reconstruction. Conclusion To reduce the incidence of colostomy complications, the operation should avoid excessive bowel tension in the stoma, mesenteric disconnection too much; reasonable choice of stoma diameter; implementation of a mucosal skin suture open stoma.