Ibn Sina Hospital, Kuwait.
Ibn Sina Hospital, Kuwait.
J Pediatr Surg. 2023 Dec;58(12):2327-2331. doi: 10.1016/j.jpedsurg.2023.08.003. Epub 2023 Aug 9.
In patients with anorectal malformation (ARM), a divided descending colostomy is associated with high complication rates, including wound infection, dehiscence, and prolapse, and it places a significant burden on caregivers. To decrease the chances of such complications, we modified our approach for colostomy fashioning by keeping an intact skin bridge between the colostomy and mucous fistula. The objective was to compare the rate of complications among patients diagnosed with ARM who underwent a modified divided descending colostomy and classical descending colostomy.
We included all the patients diagnosed with ARM who underwent a divided colostomy with modified (group A) or classical technique (group B) in the last 5 years. The type of approach used to fashion the stoma was based on the surgeon's preference than on patients' selection criteria. All patients were followed and monitored for postoperative complications. SPSS version 26 was used to analyze the data.
A total of 62 patients with ARM underwent the colostomy creation; 27 in group A and 35 in group B. Males were more in both groups and other demographic variables were comparable. The most common associated anomalies were cardiac (58%). The mean duration of surgery was 72.2 ± 18.26 min in group A while 91.25 ± 21.43 min in group B (P = 0.000). The mean hospital stay was 4.28 ± 3.63 days in group A while 7.97 ± 6.12 days in group B (P = 0.007). The overall complication rate was 14.8% in group A and 34.2% in group B (P = 0.082).
The modified approach to fashioning a divided colostomy is easily reproducible and carries a low risk of postoperative complications.
IV.
在患有肛门直肠畸形（ARM）的患者中，采用分割式降结肠造口术会导致较高的并发症发生率，包括伤口感染、裂开和脱垂，这给护理人员带来了很大的负担。为了降低此类并发症的发生几率，我们通过在结肠造口与黏膜瘘之间保留完整的皮肤桥来改变结肠造口的方式。目的是比较采用改良分割式降结肠造口术和传统降结肠造口术治疗 ARM 患者的并发症发生率。
我们纳入了过去 5 年内接受分割式结肠造口术的所有 ARM 患者，分为改良组（A 组）和传统组（B 组）。造口方式的选择基于外科医生的偏好，而非患者的选择标准。所有患者均接受随访并监测术后并发症。使用 SPSS 26 版本进行数据分析。
共有 62 例 ARM 患者接受了结肠造口术，其中 A 组 27 例，B 组 35 例。两组均以男性居多，其他人口统计学变量无差异。最常见的合并畸形为心脏畸形（58%）。A 组的手术时间平均为 72.2±18.26 分钟，B 组为 91.25±21.43 分钟（P=0.000）。A 组的平均住院时间为 4.28±3.63 天，B 组为 7.97±6.12 天（P=0.007）。A 组的总并发症发生率为 14.8%，B 组为 34.2%（P=0.082）。
改良式分割结肠造口术易于复制，且术后并发症风险较低。
IV 级。
