Beck D E, Fazio V W, Grundfest-Broniatowski S
Department of Colorectal Surgery, Wilford Hall USAF Medical Center, Lackland AFB, Texas 78236.
Dis Colon Rectum. 1988 May;31(5):343-6. doi: 10.1007/BF02564880.
A retrospective chart review of nine patients with stomal varices and portal hypertension who required surgical management of bleeding varices from 1978 to 1986 was performed. The patient's mean age at stoma formation was 46 years (range, 36 to 70 years). Three were female, six were male, and all were Caucasian. Three patients had colostomies and six had ileostomies. Indications for creation of the ostomies included inflammatory bowel disease in six patients and carcinoma in three patients. The time from creation of the stoma to the first bleed was 11 to 196 months (mean, 82 months). The average time between this bleed and surgical treatment was six months. The operative procedures performed included nine mucocutaneous disconnections (MCD) in seven patients (one for recurrent bleeding) and two stoma relocations (one for recurrence). MCD is simple, quick, and associated with a lower morbidity and intraoperative blood loss than stomal relocation. Postoperative follow-up has ranged from 4 months to 4.6 years (mean, 2.5 years). During this period there were two episodes of recurrent varices that required surgery. In the select group of patients that cannot be managed conservatively, MCD is favored and relocation considered only if MCD is technically impossible.
对1978年至1986年间9例患有造口静脉曲张和门静脉高压且需要对曲张静脉出血进行手术处理的患者进行了回顾性病历审查。患者造口形成时的平均年龄为46岁（范围36至70岁）。3例为女性，6例为男性，均为白种人。3例患者行结肠造口术，6例患者行回肠造口术。造口形成的指征包括6例炎症性肠病患者和3例癌症患者。从造口形成到首次出血的时间为11至196个月（平均82个月）。此次出血与手术治疗之间的平均时间为6个月。所施行的手术操作包括7例患者进行了9次黏膜皮肤离断术（MCD）（1例因复发出血）和2例造口重新定位术（1例因复发）。与造口重新定位相比，MCD操作简单、快速，发病率和术中失血量更低。术后随访时间为4个月至4.6年（平均2.5年）。在此期间，有2例曲张静脉复发需要再次手术。在无法进行保守治疗的特定患者组中，优先选择MCD，仅在MCD在技术上不可行时才考虑重新定位。
