肛门直肠畸形患者的结肠造口术:一种会产生严重的但可预防的并发症的疗法

作     者：Pena A. Migotto-Krieger M. Levitt M.A. 刘凯 

作者机构：Colorectal Center for ChildrenDivision of Pediatric SurgeryCincinnati Children's Hospital Medical CenterCincinnatiOH45229United States 

出 版 物：《世界核心医学期刊文摘（儿科学分册）》 (Dkgest of the World Latest Medical Information)

年 卷 期：2006年第2卷第9期

页      面：42-43页

学科分类：1002[医学-临床医学] 100202[医学-儿科学] 10[医学] 

主　　题：肛门直肠畸形 结肠造口术 肠脱垂 矫形重建术 造瘘口 结肠造口关闭术 肛肠外科 会阴区 医疗记录 肠 

摘      要：Purpose:Colostomy for patients with anorectal malformations decompresses an obstructed colon,avoids fecal contamination of the urinary tract,and protects a future perineal operation. The procedure is associated with several significant complications. Materials and Methods:The medical records of 1700 cases of anorectal malformations were retrospectively reviewed. A total of 230 patients underwent reconstruction without a colostomy. Of the remaining 1470 patients,1420 had their colostomy performed at another institution (group A) and 50 did at our institution (group B) using a specific technique with separated stomas in the descending colon. Results:There were 616 complications identified in 464 patients of group A and in 4 patients in group B,an incidence of 33% vs 8% (P 0.01). Complications in group A were classified into several groups. The first group was mislocation (282 cases),including 116 with stomas too close to each other,97 with stomas located too distally in the rectosigmoid (which interfered with the pullthrough),30 with inverted stomas,21 with stomas too far apart from each other,and 18 with right upper sigmoidostomies. The second largest group was prolapse (119 cases),which occurred mainly in mobile portions of the colon. The third group was composed of general surgical complications after colostomy closure (82 cases),such as intestinal obstruction (47 cases),wound infection (13 cases),incisional hernia (11 cases),anastomotic dehiscence (7 cases),sepsis (3 cases),and bleeding (1 case). Two of the septic patients died. Another group included 62 patients who received a Hartmann’s procedure,which we considered to be contraindicated in anorectal malformations. A total of 42 patients suffered from stenosis of the stoma; 29,from retraction. Conclusions:Most colostomy complications are preventable using separated stomas in the descending colon. Mislocated stomas lead to problems with appliance application,interference with the pull-through,megasigmoid,distal