Sherman Karen L, Wexner Steven D
Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida.
Clin Colon Rectal Surg. 2017 Jul;30(3):172-177. doi: 10.1055/s-0037-1598157. Epub 2017 May 22.
Temporary stomas are frequently used in the management of diverticulitis, colorectal cancer, and inflammatory bowel disease. These temporary stomas are used to try to mitigate septic complications from anastomotic leaks and to avoid the need for reoperation. Once acute medical conditions have improved and after the anastomosis has been proven to be healed, stomas can be reversed. Contrast enemas, digital rectal examination, and endoscopic evaluation are used to evaluate the anastomosis prior to reversal. Stoma reversal is associated with complications including anastomotic leak, postoperative ileus, bowel obstruction, enterocutaneous fistula, and, most commonly, surgical site infection. Furthermore, many stomas, which were intended to be temporary, may not be reversed due to postoperative complications, adjuvant therapy, or prohibitive comorbidities.
临时造口常用于憩室炎、结直肠癌和炎症性肠病的治疗。这些临时造口用于试图减轻吻合口漏引起的感染性并发症,并避免再次手术的需要。一旦急性病情改善且吻合口已被证实愈合,造口即可回纳。在回纳之前,使用对比灌肠、直肠指检和内镜评估来评估吻合口。造口回纳与多种并发症相关,包括吻合口漏、术后肠梗阻、肠梗阻、肠皮肤瘘,最常见的是手术部位感染。此外,许多原本打算作为临时造口的,可能由于术后并发症、辅助治疗或严重的合并症而无法回纳。