Caricato M, Ausania F, Ripetti V, Bartolozzi F, Campoli G, Coppola R
Department of Surgery, Campus Bio-Medico University, Rome, Italy.
Colorectal Dis. 2007 Jul;9(6):559-61. doi: 10.1111/j.1463-1318.2006.01187.x.
Defunctioning stoma is a common surgical procedure, but the choice of stoma remains controversial. The preference for colostomy or ileostomy depends on the type of surgery and on the surgeon who performs the procedure. Stoma reversal is often performed a few weeks after colorectal resection but few studies have analysed the long-term complications of different types of stoma. This study aims to determine which type of stoma is associated with a lower rate of long-term complications.
A retrospective study of patients undergoing colorectal surgery from 1998 to 2004 with stoma creation after was conducted. Only patients followed up by our enterostomal therapist for a minimum of 3 months were included. Both emergency and elective procedures were considered. All stoma-related complications were recorded. Kruskal-Wallis and Mann-Whitney U-test were used for statistical analysis (Reviewer 2, n. 5).
132 patients were considered suitable for the analysis. Patients were divided into loop ileostomy (44), loop colostomy (77) and end colostomy (11) group. Mean age was 68 years. Mean follow up was 4 months (range: 3-23). The overall complication rate was 60%. The most common complication included dermatitis, parastomal hernia, leakage and stenosis. The stoma with the lowest complications rate was end colostomy (P = 0.026). Age <68 years was significantly associated with less complications (P = 0.01). Indication for surgery, emergency procedure, gender, morbidity and preoperative site were not significant factors.
In this long term follow-up study, end colostomy and younger patients had a lower incidence of complications. A large prospective trial is needed to confirm our results.
造口失功是一种常见的外科手术，但造口的选择仍存在争议。结肠造口术或回肠造口术的偏好取决于手术类型和实施手术的外科医生。结肠直肠切除术后几周常进行造口还纳，但很少有研究分析不同类型造口的长期并发症。本研究旨在确定哪种类型的造口与较低的长期并发症发生率相关。
对1998年至2004年接受结肠直肠手术并在术后造口的患者进行回顾性研究。仅纳入由我们的造口治疗师随访至少3个月的患者。急诊和择期手术均纳入考虑。记录所有与造口相关的并发症。采用Kruskal-Wallis检验和Mann-Whitney U检验进行统计分析（审阅者2，第5条）。
132例患者被认为适合进行分析。患者分为回肠袢式造口组（44例）、结肠袢式造口组（77例）和结肠端式造口组（11例）。平均年龄为68岁。平均随访时间为4个月（范围：3 - 23个月）。总体并发症发生率为60%。最常见的并发症包括皮炎、造口旁疝、渗漏和狭窄。并发症发生率最低的造口类型是结肠端式造口（P = 0.026）。年龄<68岁与较少的并发症显著相关（P = 0.01）。手术指征、急诊手术、性别、发病率和术前部位不是显著因素。
在这项长期随访研究中，结肠端式造口和年轻患者的并发症发生率较低。需要进行大型前瞻性试验来证实我们的结果。
