Schleicher C, Senninger N, Vowinkel T, Anthoni C
Klinik und Poliklinik für Allgemein- und Viszeralchirurgie, Münster, Deutschland.
Chirurg. 2010 Nov;81(11):978-81. doi: 10.1007/s00104-010-1931-5.
Prolapse and retraction of an intestinal stoma are postoperative complications which severely decrease the quality of life of patients and in some cases lead to an operative revision. Both entities should be treated with sophisticated care by specialized stoma therapists in the early phase in order to prevent secondary problems such as dermal ulceration. However, in case of additional problems, such as ileus, bleeding, incarceration or impossibility of adequate stoma care, an operative revision is indicated. It remains an individual decision whether a local or a transabdominal revision of the stoma is necessary.At present the level of information and the number of well designed studies dealing with prolapse or retraction of a stoma are unsatisfactory and there are merely studies which report on prolapse and retraction as an incidental finding rather than primarily focusing on these problems. In addition there is a lack of clear cut definitions for both entities which would allow a comparison of data obtained in different studies.There is clearly a demand for a structured scientific clarification as the occurrence of stomal retraction or prolapse may present psychological and medical problems for the patients and therefore needs to be treated, conservatively and/or operatively, by both stoma specialists and surgeons.
肠造口脱垂和回缩是术后并发症,严重降低患者生活质量,在某些情况下会导致再次手术。这两种情况在早期都应由专业的造口治疗师精心护理,以预防诸如皮肤溃疡等继发问题。然而,如果出现其他问题,如肠梗阻、出血、嵌顿或无法进行充分的造口护理,则需要进行手术修复。是否需要对造口进行局部或经腹修复,仍需个体化决定。目前,关于造口脱垂或回缩的信息水平以及设计良好的研究数量都不尽人意,仅有一些研究将脱垂和回缩作为偶然发现进行报告,而非主要关注这些问题。此外,对于这两种情况缺乏明确的定义,这使得不同研究中获得的数据难以比较。显然需要进行结构化的科学阐释,因为造口回缩或脱垂的发生可能给患者带来心理和医疗问题,因此需要造口专科医生和外科医生进行保守和/或手术治疗。