Patwardhan N, Kiely E M, Drake D P, Spitz L, Pierro A
Department of Paediatric Surgery, The Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, University College London, London, England, UK.
J Pediatr Surg. 2001 May;36(5):795-8. doi: 10.1053/jpsu.2001.22963.
The aim of this study was to characterize the type and incidence of complications related to colostomy formation in newborn infants with anorectal anomalies.
The authors reviewed a 5-year (1994 to 1999) experience of a single institution in the management of neonates with high and intermediate anorectal anomalies who required colostomy at birth. Patients with colostomy still in place have been excluded from the study to maximize the chances of detecting colostomy-related complications.
There were 80 neonates with anorectal malformations, of whom, 49 (31 boys and 18 girls) were included in the study. The site of colostomy was sigmoid colon (n = 32), transverse colon (n = 7), and descending colon (n = 10). Thirty-nine colostomies were loop, and the remaining 7 were divided. The median birth weight was 2.96 kg (range, 1.46 to 3.88). The age at colostomy formation was 2 days (range, 1 to 210). Mechanical complications related to colostomy formation were observed in 16 infants (32%) with 3 infants having more than 1 mechanical complication. These included prolapse in 8 (50%), intestinal obstruction (adhesions, intussusception, and volvulus) in 7 (44%), and skin dehiscence in 3 (19%). One neonate had necrotizing enterocolitis (NEC) after colostomy formation. Urinary tract infection was observed after colostomy in 14 infants (29%). The incidence of urinary tract infection was not higher in infants who had loop colostomy (11 of 39, 28%) compared with infants who had divided colostomy (3 of 10, 30%). There were no differences in the incidence of colostomy-related complications and urinary tract infection between male and female infants. There were no deaths in this series.
Formation of colostomy for anorectal anomalies should not be considered a minor procedure. In our experience the incidence of complications after colostomy formation is high. The incidence of urinary tract infections does not seem to be affected by the type of colostomy performed.
本研究旨在描述新生儿肛门直肠畸形行结肠造口术后相关并发症的类型及发生率。
作者回顾了一家机构5年（1994年至1999年）间对出生时需要行结肠造口术的高位和中位肛门直肠畸形新生儿的治疗经验。为最大程度地发现与结肠造口相关的并发症，仍保留结肠造口的患者被排除在研究之外。
有80例肛门直肠畸形新生儿，其中49例（31例男孩和18例女孩）被纳入研究。结肠造口的部位为乙状结肠（n = 32）、横结肠（n = 7）和降结肠（n = 10）。39例结肠造口为袢式，其余7例为分流式。中位出生体重为2.96 kg（范围1.46至3.88）。结肠造口形成时的年龄为2天（范围1至210）。16例婴儿（32%）观察到与结肠造口形成相关的机械性并发症，3例婴儿有不止1种机械性并发症。其中包括8例（50%）脱垂、7例（44%）肠梗阻（粘连、肠套叠和肠扭转）和3例（19%）皮肤裂开。1例新生儿在结肠造口形成后发生坏死性小肠结肠炎（NEC）。14例婴儿（29%）在结肠造口术后观察到尿路感染。与分流式结肠造口的婴儿（10例中的3例，30%）相比，袢式结肠造口的婴儿（39例中的11例，28%）尿路感染的发生率并不更高。男婴和女婴在结肠造口相关并发症和尿路感染的发生率上没有差异。本系列无死亡病例。
肛门直肠畸形的结肠造口形成不应被视为一个小手术。根据我们的经验，结肠造口形成后的并发症发生率很高。尿路感染的发生率似乎不受所施行结肠造口类型的影响。
