Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, S-1, W-17, Chuo-ku, Sapporo, Hokkaido, 060-8556, Japan.
World J Surg. 2017 Dec;41(12):3205-3211. doi: 10.1007/s00268-017-4128-y.
Fashioning an ileostomy in the umbilicus and combining the trauma from extraction of colorectum with that from ileostomy should be less invasive and lead to improved cosmetic outcomes. However, there are only a few reports regarding umbilical ileostomy.
We retrospectively collected data for 121 consecutive patients with rectal tumor who underwent elective laparoscopic rectal resection with diverting loop ileostomy between 2010 and 2015 at Osaka University Hospital, Japan. The safety and feasibility of umbilical diverting loop ileostomy and its influence on stoma care were investigated.
A total of 83 patients were included in this study; of these, 30 underwent umbilical diverting loop ileostomy and 53 underwent conventional diverting loop ileostomy, which was created in the right lower quadrant of the abdomen. The umbilical and conventional groups showed similar rates of postoperative and stoma-related complications (26.7 vs. 32.1%, p = 0.804 and 3.3 vs. 3.8%, p = 1.000, respectively). Level of parastomal dermatitis was evaluated by DET score at three time points (stoma self-management establishment, first outpatient review post-discharge, and just before stoma closure). DET scores at any time points did not differ significantly between the two groups.
Umbilical diverting loop ileostomy is comparable to conventional ileostomy with regard to safety and feasibility. Our methods for umbilical ileostomy using the umbilical skin flap were less invasive and did not have a negative impact on stoma care and parastomal dermatitis. Umbilical ileostomy may be a promising alternative to conventional ileostomy in selected cases.
在脐部行回肠造口术，并将结直肠切除的创伤与回肠造口术的创伤结合起来，应该具有更小的侵袭性，并导致更好的美容效果。然而，关于脐部回肠造口术的报道很少。
我们回顾性地收集了 2010 年至 2015 年期间在日本大阪大学医院接受腹腔镜直肠切除术和预防性回肠造口术的 121 例直肠肿瘤患者的数据。研究了脐部旁路回肠造口术的安全性和可行性及其对造口护理的影响。
共有 83 例患者纳入本研究；其中 30 例行脐部旁路回肠造口术，53 例行传统的右下腹旁路回肠造口术。脐部和传统组术后和造口相关并发症的发生率相似（26.7%比 32.1%，p=0.804 和 3.3%比 3.8%，p=1.000）。在三个时间点（造口自我管理建立、出院后第一次门诊复查和造口关闭前）评估了造口周围皮炎的 DET 评分。两组任何时间点的 DET 评分均无显著差异。
脐部旁路回肠造口术与传统回肠造口术在安全性和可行性方面相当。我们使用脐部皮瓣的脐部肠造口术方法具有较小的侵袭性，对造口护理和造口周围皮炎没有负面影响。在选择病例中，脐部肠造口术可能是一种有前途的替代传统肠造口术的方法。
