Edwards D P, Leppington-Clarke A, Sexton R, Heald R J, Moran B J
Colorectal Research Unit, North Hampshire Hospital, Aldermaston Road, Basingstoke RG24 9NA, UK.
Br J Surg. 2001 Mar;88(3):360-3. doi: 10.1046/j.1365-2168.2001.01727.x.
The consequences of leakage from low colorectal or coloanal anastomoses are reduced by the use of a loop stoma to divert the faecal stream. Controversy continues as to whether loop ileostomy (LI) or loop transverse colostomy (LTC) is the optimal method of defunctioning such anastomoses.
Patients requiring defunctioning following anterior resection and total mesorectal excision were randomized to receive either LI or LTC. Comparison was made between the groups regarding the difficulty of stoma formation and closure, the recovery after stoma closure and stoma-related complications. The minimum follow-up after stoma closure was 6 months (median 36 months).
Between October 1995 and August 1999, 70 patients were randomized (LTC 36, LI 34) of whom 63 underwent stoma closure (LTC 31, LI 32). There were no significant differences in the difficulty of formation or closure, or in the postoperative recovery between the groups. However, there were ten complications related directly to the stoma in the LTC group: faecal fistula (one patient), prolapse (two), parastomal hernia (two) and incisional hernia during follow-up (five). None of these complications occurred in the LI group.
In this randomized study, the frequency of herniation before or after colostomy closure supports the choice of LI as a method of defunctioning a low anastomosis. Both methods appear to provide satisfactory protection for the low anastomosis.
通过使用袢式造口使粪便改道，可减少低位结直肠或结肠肛管吻合口漏的后果。关于袢式回肠造口术（LI）和袢式横结肠造口术（LTC）哪种是使此类吻合口功能丧失的最佳方法，仍存在争议。
前切除术和全直肠系膜切除术后需要行功能丧失造口术的患者被随机分为LI组或LTC组。比较两组造口形成和关闭的难度、造口关闭后的恢复情况以及与造口相关的并发症。造口关闭后的最短随访时间为6个月（中位时间36个月）。
1995年10月至1999年8月期间，70例患者被随机分组（LTC组36例，LI组34例），其中63例患者接受了造口关闭术（LTC组31例，LI组32例）。两组在造口形成或关闭的难度以及术后恢复方面无显著差异。然而，LTC组有10例与造口直接相关的并发症：随访期间粪便瘘（1例患者）、脱垂（2例）、造口旁疝（2例）和切口疝（5例）。LI组未发生这些并发症。
在这项随机研究中，结肠造口关闭前后的疝形成频率支持选择LI作为低位吻合口功能丧失的一种方法。两种方法似乎都能为低位吻合口提供满意的保护。
