Balducci T, Camoglio F S, Cecchetto M, Giacomello L, Dipaola G, Rigo V, Ottolenghi A
Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Università degli Studi, Verona, Italy.
Minerva Chir. 2002 Feb;57(1):87-91.
Diverting colostomy is commonly required in surgical emergencies of the distal colon, especially if the patient is in poor condition. This paper shows that the colostomy could be unnecessary in most cases. In the last 10 years, 6 patients (4 with high-risk or postoperative complicated Hirschsprung disease, 1 with intestinal neuronal dysplasia and 1 with iatrogenic rectal stenosis obstruction) have been submitted to primary continent perineal colostomy-modified Duhamel's procedure. The modified technique consists of the exteriorization of the normal colon or ileum by a retrorectal and trans-anal way, while the excision of redundant tissue and rectal spur section are postponed at least for 10 days. In personal experience this peculiar surgical approach allows to avoid not only the complications due to the fashioning of a contraindicated primary anastomosis, but even those due to stomy performance and its closure, promoting good anatomo-functional results in all patients. The advantages of modified Duhamel's operation compared to other procedures (Swenson-Pellerin or Soave pull-through) depend on the rapidity of execution and on the quality of short and long term outcome.
在远端结肠的外科急症中，通常需要进行改道结肠造口术，尤其是在患者情况较差时。本文表明，在大多数情况下结肠造口术可能是不必要的。在过去10年中，6例患者（4例患有高危或术后复杂性先天性巨结肠病，1例患有肠道神经元发育异常，1例患有医源性直肠狭窄梗阻）接受了一期可控性会阴结肠造口术改良杜哈梅尔手术。改良技术包括通过直肠后和经肛门的方式将正常结肠或回肠外置，而多余组织的切除和直肠嵴切除至少推迟10天。根据个人经验，这种独特的手术方法不仅可以避免因进行禁忌的一期吻合而导致的并发症，甚至可以避免因造口操作及其关闭而导致的并发症，在所有患者中都能促进良好的解剖功能结果。与其他手术（斯文森-佩勒林或索阿韦拖出术）相比，改良杜哈梅尔手术的优势取决于手术执行的速度以及短期和长期结果的质量。
