Minaev S V, Bykov N I, Isaeva A V, Kachanov A V, Tovkan E A, Filip'yeva N V, Gerasimenko I N
Stavropol State Medical University, Russian Federation.
Regional Children Clinical Hospital, Stavropol, Russia.
Khirurgiia (Mosk). 2017(1):54-57. doi: 10.17116/hirurgia2017154-57.
To investigate the complications of intestinal stoma in children and to develop measures for decrease of their incidence.
The study included 152 children with congenital and acquired gastrointestinal pathology requiring surgical treatment with the imposition of intestinal stoma. Atresia of intestinal tube was observed in 28 (18.4%) children, meconium ileus - in 10 (6.6%) cases, Hirschsprung's disease - in 11 (7.2%)cases, anorectal malformations - in 39 (25.7%) cases, multiple malformations - in 11 (7.2%) patients, necrotic enterocolitis - in 56 (36.8%) patients, other reasons - in 7 (4.6%) cases. The average age of patients was 12,3±7,2 days. There were 93 (61.2%) boys and 59 (38.8%) girls. Ileostomy, ileocolostomy and colostomy were made in 37 (24.3%), 46 (30.3%) and 69 (45.4%) cases respectively. Time of intestinal stoma function was 18-217 days.
Early complications were dehiscence in the area of stoma in 4 (2.6%) children, evagination in 7 (4.6%) patients, marginal necrosis of stoma in 2 (1.3%) cases, retraction of stomy into abdominal cavity in 1 (0.6%) child and abdominal skin maceration in 8 (5.2%) patients. Remote complications included dermatitis around stomy in 35 (23.1%) children, stenosis of stoma in 9 (5.9%) cases, evagination of stoma in 12 (7.9%) patients. Also, 5 patients were unable to use the colostomy bag due to vicious overlaying of intestinal stoma. Using the colostomy bags «Coloplast» and skin care products around the stoma significantly reduced (p<0.01) the number of complications at inpatient stage of treatment.
Successful function of stoma depends on not only technical aspects but also obligatory care performance with timely correction of complications.
探讨儿童肠造口的并发症，并制定降低其发生率的措施。
本研究纳入152例患有先天性和后天性胃肠道疾病且需要手术治疗并施行肠造口的儿童。28例（18.4%）儿童观察到肠管闭锁，10例（6.6%）为胎粪性肠梗阻，11例（7.2%）为先天性巨结肠，39例（25.7%）为肛门直肠畸形，11例（7.2%）为多发畸形，56例（36.8%）为坏死性小肠结肠炎，7例（4.6%）为其他原因。患者的平均年龄为12.3±7.2天。男孩93例（61.2%），女孩59例（38.8%）。分别行回肠造口术37例（24.3%）、回结肠造口术46例（30.3%）和结肠造口术69例（45.4%）。肠造口功能时间为18 - 217天。
早期并发症包括4例（2.6%）儿童造口部位裂开，7例（4.6%）患者造口脱垂，2例（1.3%）造口边缘坏死，1例（0.6%）儿童造口回缩至腹腔，8例（5.2%）患者腹部皮肤浸渍。远期并发症包括35例（23.1%）儿童造口周围皮炎，9例（5.9%）造口狭窄，12例（7.9%）患者造口脱垂。此外，5例患者因肠造口恶性覆盖而无法使用结肠造口袋。使用“康乐保”结肠造口袋和造口周围皮肤护理产品显著降低了（p<0.01）治疗住院阶段的并发症数量。
造口的成功功能不仅取决于技术方面，还取决于必要的护理操作以及及时纠正并发症。
