Ishiguro Seiji, Komatsu Shunichiro, Ando Keiichi, Osawa Takaaki, Yasui Kohei, Arikawa Takashi, Ohashi Norifumi, Miyachi Masahiko, Sano Tsuyoshi
Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan.
Asian J Endosc Surg. 2017 Feb;10(1):79-82. doi: 10.1111/ases.12316.
We examined the feasibility of umbilical diverting ileostomy for overweight and obese patients with rectal cancer undergoing laparoscopic surgery. Four patients who were overweight or obese (BMI > 27 kg/m ) were initially scheduled for the creation of a conventional loop ileostomy. Intraoperatively, however, this was considered too complicated because of thick subcutaneous fat, bulky mesentery, or both. Instead, patients received a diverting ileostomy with the placement of an umbilical stoma. All patients had protruding umbilical ileostomies. No severe stoma-related complications were encountered. One patient had minor skin dehiscence, and another had paralytic ileus but resumed oral intake after a short time. Performing a temporary loop ileostomy at the umbilicus was safe and feasible in this small group of overweight and obese patients. This stoma placement may avoid the problems inherent to conventional loop ileostomy in obese subjects.
我们研究了脐部转流回肠造口术用于接受腹腔镜手术的超重和肥胖直肠癌患者的可行性。4例超重或肥胖（BMI>27kg/m²）的患者最初计划行传统袢式回肠造口术。然而，术中发现由于皮下脂肪厚、肠系膜肥厚或两者兼而有之，实施传统袢式回肠造口术过于复杂。取而代之的是，患者接受了带有脐部造口的转流回肠造口术。所有患者的脐部回肠造口均有突出。未遇到严重的造口相关并发症。1例患者出现轻微皮肤裂开，另1例患者发生麻痹性肠梗阻，但短时间后恢复经口进食。在这一小群超重和肥胖患者中，在脐部行临时袢式回肠造口术是安全可行的。这种造口位置可避免肥胖患者传统袢式回肠造口术固有的问题。
