Chandramouli B, Srinivasan K, Jagdish S, Ananthakrishnan N
Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
J Pediatr Surg. 2004 Apr;39(4):596-9. doi: 10.1016/j.jpedsurg.2003.12.016.
This study evaluated the complications of colostomy and its closure in infants and children.
One hundred forty-six colostomies were performed in 86 neonates, 23 infants, and 37 children older than 1 year. These children underwent colostomies for anorectal malformation (84), Hirschsprung's disease (47), and other miscellaneous (15) conditions like colonic atresia, volvulus, rectal tuberculosis, traumatic rectal perforation, and intestinal obstruction caused by ascariasis.
Of these, 17 (11.6%) had early complications, and 80 (69.8%) had stomal complications. Three patients died, but only 1 death was directly related to colostomy. Colostomy prolapse, peristomal excoriation, and malnutrition were the major complications. The complications were not dependant on the children's age or primary indication. Sigmoid colostomy had a lower malnutrition rate than transverse colostomy (34.9% v 16.9% P =.009). Among the 56 children who underwent colostomy closure, major complications include death (1.8%), anastomotic leak (7.1%), and wound infection (12.6%).
A divided sigmoid colostomy should be performed whenever possible. Proper stomal care, regular nutritional assessment, and early closure of the colostomy would minimize morbidity and mortality of colostomy and its closure.
本研究评估了婴幼儿结肠造口术及其关闭术的并发症。
对86例新生儿、23例婴儿和37例1岁以上儿童实施了146例结肠造口术。这些儿童因肛门直肠畸形（84例）、先天性巨结肠（47例）以及其他各种情况（15例，如结肠闭锁、肠扭转、直肠结核、外伤性直肠穿孔和蛔虫引起的肠梗阻）接受结肠造口术。
其中17例（11.6%）发生早期并发症，80例（69.8%）发生造口并发症。3例患者死亡，但只有1例死亡与结肠造口术直接相关。结肠造口脱垂、造口周围皮肤糜烂和营养不良是主要并发症。并发症与儿童年龄或主要适应证无关。乙状结肠造口术的营养不良发生率低于横结肠造口术（34.9%对16.9%，P = 0.009）。在56例接受结肠造口关闭术的儿童中，主要并发症包括死亡（1.8%）、吻合口漏（7.1%）和伤口感染（12.6%）。
只要有可能，应尽可能行乙状结肠造口术。适当的造口护理、定期的营养评估以及早期关闭结肠造口可将结肠造口术及其关闭术的发病率和死亡率降至最低。
