Säuberli H, Tedaldi R
Chirurgische Klinik, Kantonsspital Baden, Schweiz.
Zentralbl Chir. 1998;123(12):1370-4.
Patients with small bowel obstruction hardly ever need a stoma. Advanced peritoneal carcinomatosis (mostly due to colorectal or ovarial cancer) may require a proximal palliative fecal diversion. Likewise stomatas for colonic ileus became less frequent. The type of the stoma and its necessity depend on the patient's condition, on the duration and the cause of the obstruction, i.e. on the condition and the damage of the bowel. Terminal sigmoidostomy has its place mainly as a part of the Hartmann's procedure treating sigmoid diverticulitis with inflammatory pseudotumor, with free perforation and diffuse peritonitis. For oncological reasons Hartmann's resection should not be performed for rectal cancer--except for very old patients in bad condition. Colonic ileus due to colorectal cancer can usually be treated by resection and primary anastomosis. In case of delayed ileus it may be better to resect the proximal colon and to perform an ileocolostomy to avoid complications. Risky anastomoses due to damaged bowel or for patients in bad condition may be protected by a loop-ileostomy or a loop transverse colostomy. They are both easy to perform and to close with very few complications. Summarizing we may conclude that very few patients really need a stoma today--patients showing special risks such as diffuse peritonitis, absceding inflammation or damaged bowel as a result of delayed ileus.
小肠梗阻患者很少需要造口。晚期腹膜癌（主要由结直肠癌或卵巢癌引起）可能需要近端姑息性粪便转流。同样，用于结肠梗阻的造口也变得不那么常见了。造口的类型及其必要性取决于患者的病情、梗阻的持续时间和原因，即取决于肠道的状况和损伤程度。末端乙状结肠造口主要作为哈特曼手术的一部分，用于治疗伴有炎性假瘤、游离穿孔和弥漫性腹膜炎的乙状结肠憩室炎。出于肿瘤学原因，除了病情很差的老年患者外，直肠癌不应进行哈特曼切除术。结直肠癌引起的结肠梗阻通常可通过切除和一期吻合术治疗。对于延迟性肠梗阻，切除近端结肠并进行回结肠造口术可能更好，以避免并发症。因肠道受损或患者病情较差而有风险的吻合口可通过袢式回肠造口术或袢式横结肠造口术进行保护。这两种造口术都易于实施和关闭，并发症很少。总之，我们可以得出结论，如今真正需要造口的患者很少——那些存在特殊风险的患者，如弥漫性腹膜炎、脓肿性炎症或因延迟性肠梗阻导致肠道受损的患者。
