Carlsson Eva, Fingren Jeanette, Hallén Anne-Marie, Petersén Charlotta, Lindholm Elisabet
Institute of Clinical Sciences, Sahlgrenska University Hospital/Östra and Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Sweden.
Institute of Clinical Sciences, Sahlgrenska University Hospital/Östra.
Ostomy Wound Manage. 2016 Oct;62(10):34-48.
Despite advancements in the creation and care of stomas, ostomy and peristomal skin complications are common immediately following surgery as well as in the months and years thereafter. A prospective study to determine the prevalence of ostomy and peristomal skin complications and the influence of ostomy configuration on such complications was conducted 1 year after ostomy surgery among all patients at a university hospital in Sweden. All participants received regular (10 to 14 days post discharge, 6 weeks, 3 months, 6 months, and 1 year post surgery) ostomy follow-up care by a wound ostomy continence (WOC) nurse. All consecutive elective and emergency patients who had undergone surgery to create a colostomy (end colostomy), end ileostomy, or loop ileostomy were eligible to participate. Patients who were reoperated during their first year post-surgery, patients with a urostomy, and patients with double ostomies were excluded from the study. Patient data collected included age, gender, diagnosis, elective or emergency surgery, open or laparoscopic surgical procedure, presence of a colorectal surgeon specialist at surgery, type of ostomy (colostomy, end ileostomy, loop ileostomy), preoperative ostomy siting, counseling, body mass index, American Society of Anesthesiologists classification, and radiation and/or chemotherapy status. Ostomies were evaluated by 4 WOC nurses as to stoma configuration, convexity use, patient self-sufficiency in stoma care, and complications. All 207 patients (53% women) who were eligible agreed to participate in the study. Patient median age was 70 years (range 19-94); 74% underwent elective surgery. Main diagnoses were colorectal cancer (62%) and inflammatory bowel disease (19%). Ostomy types were: colostomy (71%), end ileostomy (26%), and loop ileostomy (3%). One or more complications occurred in 35% of the patients (27% ostomy complications, 11% peristomal skin complications). A colostomy hernia was the most common surgical complication (20%), and significantly more women (69%) and emergency surgeries were noted among patients with a colostomy and an ostomy height of ≤5 mm. The use of convexity was significantly more common among patients with a stoma height of ≤5 mm than patients with stomas >5 mm (P = 0.016) and among patients having emergency operations than among patients having elective surgery (P = 0.045). Of the emergency surgeries, 37% had not been ostomy-sited (P <0.0001). With regular WOC nurse follow-up, the prevalence of peristomal skin complications in this population was low, and adequate ostomy height might have prevented the frequent use of convexity. Explorative studies are needed that consider differences in body configuration when determining optimal stoma height, especially for patients who require emergency surgery.
尽管在造口的创建和护理方面取得了进展，但造口及造口周围皮肤并发症在术后即刻以及随后的数月和数年中都很常见。瑞典一家大学医院对所有接受造口手术1年后的患者进行了一项前瞻性研究，以确定造口及造口周围皮肤并发症的发生率以及造口形态对这些并发症的影响。所有参与者在出院后10至14天、术后6周、3个月、6个月和1年接受伤口造口失禁（WOC）护士的定期造口随访护理。所有接受结肠造口术（端式结肠造口）、回肠造口术或袢式回肠造口术的连续择期和急诊患者均有资格参与。术后第一年再次手术的患者、有尿路造口的患者以及有双造口的患者被排除在研究之外。收集的患者数据包括年龄、性别、诊断、择期或急诊手术、开放或腹腔镜手术、手术时有结直肠外科专家在场、造口类型（结肠造口、回肠造口、袢式回肠造口）、术前造口定位、咨询、体重指数、美国麻醉医师协会分级以及放疗和/或化疗状态。4名WOC护士对造口的形态、凸面使用情况、患者在造口护理方面的自理能力以及并发症进行了评估。所有207名符合条件的患者（53%为女性）均同意参与该研究。患者中位年龄为70岁（范围19 - 94岁）；74%接受择期手术。主要诊断为结直肠癌（62%）和炎症性肠病（19%）。造口类型为：结肠造口（71%）、回肠造口（26%）和袢式回肠造口（3%）。35%的患者发生了一种或多种并发症（27%为造口并发症，11%为造口周围皮肤并发症）。结肠造口疝是最常见的手术并发症（20%），结肠造口且造口高度≤5 mm的患者中女性（69%）和急诊手术患者明显更多。造口高度≤5 mm的患者比造口高度>5 mm的患者更常使用凸面（P = 0.016），急诊手术患者比择期手术患者更常使用凸面（P = 0.045）。在急诊手术中，37%未进行造口定位（P <0.0001）。通过WOC护士的定期随访，该人群中造口周围皮肤并发症的发生率较低，适当的造口高度可能避免频繁使用凸面。需要进行探索性研究，在确定最佳造口高度时考虑身体形态的差异，尤其是对于需要急诊手术的患者。
