Piotr Zelga, MD, PhD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland.
Piotr Kluska, MD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland.
J Wound Ostomy Continence Nurs. 2021;48(5):415-430. doi: 10.1097/WON.0000000000000796.
PURPOSE: Ostomy creation is often an integral part of the surgical management of various diseases including colorectal malignancies and inflammatory bowel disease. Stoma and peristomal complications may occur in up to 70% of patients following ostomy surgery. The aim of this scoping literature review was to synthesize evidence on the risk factors for developing complications following creation of a fecal ostomy. DESIGN: Scoping literature review. SEARCH STRATEGY: Two independent researchers completed a search of the online bibliographic databases PubMed, MEDLINE, Cochrane, Google Scholar, and EMBASE for all articles published between January 1980 and December 2018. The search comprised multiple elements including systematic literature reviews with meta-analysis of pooled findings, randomized controlled trials, cohort studies, observational studies, other types of review articles, and multiple case reports. We screened 307 unique titles and abstracts; 68 articles met our eligibility criteria for inclusion. The methodological rigor of study quality included in our scoping review was variable. FINDINGS/CONCLUSIONS: We identified 6 risk factors associated with an increased likelihood of stoma or peristomal complications (1) age more than 65 years; (2) female sex; (3) body mass index more than 25; (4) diabetes mellitus as a comorbid condition; (5) abdominal malignancy as the underlying reason for ostomy surgery; and (6) lack of preoperative stoma site marking and WOC/ostomy nurse specialist care prior to stoma surgery. We also found evidence that persons with a colostomy are at a higher risk for prolapse and parastomal hernia. IMPLICATIONS: Health care professionals should consider these risk factors when caring for patients undergoing fecal ostomy surgery and manage modifiable factors whenever possible. For example, preoperative stoma site marking by an ostomy nurse or surgeon familiar with this task, along with careful perioperative ostomy care and education of the patient by an ostomy nurse specialist, are essential to reduce the risk of modifiable risk factors related to creation of a fecal ostomy.
目的:造口术通常是治疗各种疾病(包括结直肠恶性肿瘤和炎症性肠病)的外科治疗的一个组成部分。造口和造口周围并发症可能发生在高达 70%的肠造口手术后患者中。本次范围文献综述的目的是综合有关形成粪便造口术后发生并发症的危险因素的证据。
设计:范围文献综述。
搜索策略:两名独立的研究人员在 1980 年 1 月至 2018 年 12 月期间,在在线书目数据库 PubMed、MEDLINE、Cochrane、Google Scholar 和 EMBASE 中完成了一项搜索,检索了所有文章。搜索包括系统文献综述和荟萃分析的综合发现、随机对照试验、队列研究、观察性研究、其他类型的综述文章和多个病例报告。我们筛选了 307 个独特的标题和摘要;68 篇文章符合纳入标准。我们范围综述中纳入的研究质量的方法学严谨性各不相同。
结果/结论:我们确定了 6 个与造口或造口周围并发症发生率增加相关的危险因素(1)年龄大于 65 岁;(2)女性;(3)体重指数大于 25;(4)糖尿病作为合并症;(5)腹部恶性肿瘤是肠造口术的基础原因;(6)术前造口部位标记和 WOC/造口护士专家在造口术前护理的缺乏。我们还发现证据表明,结肠造口术患者发生脱垂和造口旁疝的风险更高。
意义:医护人员在为接受粪便造口术的患者提供护理时应考虑这些危险因素,并尽可能管理可改变的因素。例如,由熟悉该任务的造口护士或外科医生进行术前造口部位标记,以及由造口护士专家进行仔细的围手术期造口护理和教育,对于减少与粪便造口形成相关的可改变危险因素至关重要。
J Wound Ostomy Continence Nurs.
J Wound Ostomy Continence Nurs. 2017
J Wound Ostomy Continence Nurs. 2008
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