Department of Gastroenterological Surgery, Iwate Prefectural Central Hospital, 1-4-1, Ueda, Morioka City, Iwate, 020-0066, Japan.
Department of Surgery, Tohoku University, 1-1, Seiryo-Cho, Aoba-Ku, Sendai City, Miyagi, 980-8574, Japan.
Surg Today. 2023 May;53(5):621-627. doi: 10.1007/s00595-022-02632-2. Epub 2022 Dec 20.
To compare the surgical outcomes of ileostomy vs. transverse colostomy and investigate which is more suitable for a diverting stoma.
We assessed stoma-related complications and surgical outcomes, retrospectively, for 146 patients who underwent laparoscopic colorectal surgery with a temporary loop ileostomy or transverse colostomy. Complications after secondary stoma closure surgery were also analyzed.
After the primary surgery, the incidence of prolapse was significantly higher in the transverse colostomy group, whereas high-output stoma and skin irritation were seen more frequently in the ileostomy group. The median interval to stoma closure was shorter in the ileostomy group than in the transverse colostomy group (144 vs. 196 days). After secondary closure surgery, the incidence of wound infection was significantly higher in the transverse colostomy group than in the ileostomy group. None of the patients in the ileostomy group had severe complications. The median postoperative hospital stay was significantly shorter in the ileostomy group than in the transverse colostomy group (10 vs. 13 days).
The findings of this study suggest that ileostomy should be the procedure of choice for short-term temporary diverting stoma, but that transverse colostomy is more appropriate for patients who require a long-term or permanent stoma.
比较回肠造口术与横结肠造口术的手术效果，并探讨哪种术式更适合作为转流性造口。
我们回顾性评估了 146 例行腹腔镜结直肠手术并接受临时性回肠造口或横结肠造口的患者的造口相关并发症和手术结果。我们还分析了二期造口关闭手术后的并发症。
在初次手术后，横结肠造口组的脱垂发生率明显更高，而回肠造口组则更常出现高输出性造口和皮肤刺激。回肠造口组的造口关闭中位时间明显短于横结肠造口组（144 天 vs. 196 天）。二期关闭手术后，横结肠造口组的伤口感染发生率明显高于回肠造口组。回肠造口组无患者发生严重并发症。回肠造口组的术后住院中位时间明显短于横结肠造口组（10 天 vs. 13 天）。
本研究结果表明，回肠造口术应作为短期临时性转流性造口的首选术式，但对于需要长期或永久性造口的患者，横结肠造口术更为合适。
