Patil Vijayraj, Vijayakumar Abhishek, Ajitha M B, Kumar L Sharath
Department of General Surgery, Victoria Hospital, Bangalore Medical College and Research Institute, Bangalore 560002, India.
ISRN Surg. 2012;2012:547523. doi: 10.5402/2012/547523. Epub 2012 Dec 18.
Aim. Loop ileostomy has high complication rates and causes much patient inconvenience. This study was performed to compare the outcome of tube versus loop ileostomy in management of ileal perforations. Patients and Methods. From July 2008 to July 2011, all patients with ileal perforation on laparotomy where a defunctioning proximal protective loop ileostomy was considered advisable were chosen for study. Patients were randomly assigned to undergo either tube ileostomy or classical loop ileostomy as the diversion procedure. Tube ileostomy was constructed in the fashion of feeding jejunostomy, with postoperative saline irrigation. Results. A total of 60 diversion procedures were performed over the period with 30 for each of tube and loop ileostomy. Typhoid and tuberculosis formed the most common etiology for ileal perforation. The complication rate of tube ileostomy was 33%. Main complications related to tube ileostomy were peritubal leak, tube blockage. In patients with loop, overall complications in 53% majority were peristomal skin irritation and wound infection following ileostomy closure. Two patients developed obstruction following ileostomy closure which needed reoperation. Conclusions. Tube ileostomy is effective and feasible as a diversion procedure and has reduced morbidity. It can be used as an alternative to loop ileostomy.
目的。袢式回肠造口术并发症发生率高，给患者带来诸多不便。本研究旨在比较管形回肠造口术与袢式回肠造口术在处理回肠穿孔方面的效果。患者与方法。选取2008年7月至2011年7月期间，所有在剖腹手术中发现回肠穿孔且认为行近端功能性保护性袢式回肠造口术适宜的患者进行研究。患者被随机分配接受管形回肠造口术或经典袢式回肠造口术作为转流手术。管形回肠造口术采用空肠造口喂养的方式构建，并在术后进行生理盐水冲洗。结果。在此期间共进行了60例转流手术，管形回肠造口术和袢式回肠造口术各30例。伤寒和结核是回肠穿孔最常见的病因。管形回肠造口术的并发症发生率为33%。与管形回肠造口术相关的主要并发症是管周渗漏、导管堵塞。在袢式回肠造口术患者中，53%的患者总体并发症是造口周围皮肤刺激和回肠造口关闭后的伤口感染。两名患者在回肠造口关闭后发生梗阻，需要再次手术。结论。管形回肠造口术作为一种转流手术是有效且可行的，并且降低了发病率。它可作为袢式回肠造口术的替代方法。
