Cottam J, Richards K, Hasted A, Blackman A
Clinical Nurse Specialist (Colorectal/Stoma Care), Bedford Hospital, NHS Trust, Kempston Road, Bedford MK42 9DJ, UK.
Colorectal Dis. 2007 Nov;9(9):834-8. doi: 10.1111/j.1463-1318.2007.01213.x. Epub 2007 Aug 2.
Actuarial analysis of stoma complications (problematic stomas) is lacking. The objectives of this audit were: to identify the incidence of stoma complications within the UK; to highlight any dissimilarity of incidence from centre to centre; to ascertain if the height of the stoma (distance of stoma lumen from the skin) at the time of fashioning is a predisposing factor to problems; and finally to initiate much needed research.
Commencing 1st January 2005, stoma care services nationwide (256) were invited to audit prospectively their next 50 enteric stomas or for a period of 1 year which ever came first. The definition of a problematic stoma being one, which needed one or more accessories to keep the patient clean and dry for a minimum period of 24 h. The incident is to have happened within 3 weeks of surgery. Factors taken into account were: type of stoma, height of stoma within 48 h of surgery; emergency or elective procedure, problem identified, BMI, gender and underlying diagnosis of the patient. The identities of the participating centres are confidential.
Of the 256 hospital-based stoma care services within the UK, 93 (36%) participated. A total of 3970 stomas were recorded, of which 1329 (34%) were identified as problematic. Sixty-two centres reported 45-50 stomas with a range of complications 6-96%. The loop ileostomy was found to be the stoma which causes most problems. A stoma of <10 mm is a predisposing factor to complications and problems are more likely to occur following an emergency procedure. More men than women have stomas formed, but have significantly fewer problems and there is no significant difference between underlying diagnoses.
The stoma height, stoma type and gender of the patient are significant risk factors identified in this audit. The BMI of patient did not affect the outcome. Patients undergoing an emergency procedure are more likely to have a problematic stoma. The significant variation of complications from centre to centre indicates surgical technique as being the key factor in stoma formation and subsequent quality of life for the patient.
目前缺乏对造口并发症（问题造口）的精算分析。本次审计的目的是：确定英国造口并发症的发生率；突出各中心发生率的差异；确定造口形成时造口的高度（造口管腔距皮肤的距离）是否是问题的诱发因素；最后开展急需的研究。
从2005年1月1日开始，邀请全国范围内的造口护理服务机构（共256家）对其接下来的50例肠造口进行前瞻性审计，或为期1年，以先到者为准。问题造口的定义是，需要一种或多种配件来保持患者清洁干燥至少24小时的造口。该事件需发生在手术后3周内。考虑的因素包括：造口类型、术后48小时内造口的高度、急诊或择期手术、发现的问题、体重指数（BMI）、性别以及患者的基础诊断。参与中心的身份是保密的。
在英国的256家医院造口护理服务机构中，93家（36%）参与了此次审计。共记录了3970例造口，其中1329例（34%）被确定为问题造口。62个中心报告了45 - 50例造口，并发症发生率在6% - 96%之间。发现袢式回肠造口是导致问题最多的造口类型。造口高度小于10毫米是并发症的诱发因素，急诊手术后更易出现问题。造口患者中男性多于女性，但男性出现问题的情况明显较少，基础诊断之间无显著差异。
本次审计确定造口高度、造口类型和患者性别是重要的风险因素。患者的BMI不影响结果。接受急诊手术的患者更易出现问题造口。各中心并发症的显著差异表明手术技术是造口形成及后续患者生活质量的关键因素。
