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肠造口并发症的外科处理:MISSTO-WSES 映射回顾。

Surgical management of ostomy complications: a MISSTO-WSES mapping review.

机构信息

General Surgery Department, Santa Maria della Misericordia Hospital, Rovigo, Italy.

General Surgery Department, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milano, Italy.

出版信息

World J Emerg Surg. 2023 Oct 10;18(1):48. doi: 10.1186/s13017-023-00516-5.


DOI:10.1186/s13017-023-00516-5
PMID:37817218
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10563348/
Abstract

BACKGROUND: The creation of an ileostomy or colostomy is a common surgical event, both in elective and in emergency context. The main aim of stoma creation is to prevent postoperative complications, such as the anastomotic leak. However, stoma-related complications can also occur and their morbidity is not negligible, with a rate from 20 to 70%. Most stomal complications are managed conservatively, but, when this approach is not resolutive, surgical treatment becomes necessary. The aim of this mapping review is to get a comprehensive overview on the incidence, the risk factors, and the management of the main early and late ostomy complications: stoma necrosis, mucocutaneous separation, stoma retraction, stoma prolapse, parastomal hernia, stoma stenosis, and stoma bleeding. MATERIAL AND METHODS: A complete literature research in principal databases (PUBMED, EMBASE, SCOPUS and COCHRANE) was performed by Multidisciplinary Italian Study group for STOmas (MISSTO) for each topic, with no language restriction and limited to the years 2011-2021. An international expert panel, from MISSTO and World Society of Emergency Surgery (WSES), subsequently reviewed the different issues, endorsed the project, and approved the final manuscript. CONCLUSION: Stoma-related complications are common and require a step-up management, from conservative stoma care to surgical stoma revision. A study of literature evidence in clinical practice for stoma creation and an improved management of stoma-related complications could significantly increase the quality of life of patients with ostomy. Solid evidence from the literature about the correct management is lacking, and an international consensus is needed to draw up new guidelines on this subject.

摘要

背景:肠造口术或结肠造口术是一种常见的手术,无论是在择期手术还是紧急情况下都需要进行。造口的主要目的是预防术后并发症,如吻合口漏。然而,也可能会发生与造口相关的并发症,其发病率不容忽视,约为 20%至 70%。大多数造口并发症可通过保守治疗来管理,但如果这种方法无效,则需要进行手术治疗。本次映射综述的目的是全面了解主要早期和晚期造口并发症的发生率、危险因素和处理方法:造口坏死、黏膜皮肤分离、造口回缩、造口脱垂、造口旁疝、造口狭窄和造口出血。

材料和方法:意大利多学科肠造口术研究组(MISSTO)在主要数据库(PUBMED、EMBASE、SCOPUS 和 COCHRANE)中对每个主题进行了全面的文献检索,无语言限制,检索年限限于 2011 年至 2021 年。MISSTO 和世界急诊外科学会(WSES)的一个国际专家小组随后审查了不同的问题,认可了该项目,并批准了最终的手稿。

结论:造口相关并发症很常见,需要进行分级管理,从保守的造口护理到手术造口修复。对造口术创建和造口相关并发症的管理进行临床实践中的文献研究,并进行改进,可显著提高造口患者的生活质量。文献中缺乏关于正确管理的确凿证据,需要制定新的指南,以就这一主题达成国际共识。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/42b4/10563348/93390b0c4da8/13017_2023_516_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/42b4/10563348/93390b0c4da8/13017_2023_516_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/42b4/10563348/93390b0c4da8/13017_2023_516_Fig1_HTML.jpg

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[1]
Surgical management of ostomy complications: a MISSTO-WSES mapping review.

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[2]
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[4]
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引用本文的文献

[1]
Study on the impact of WeChat platform continuity care on complications and self-care ability in colostomy patients.

Medicine (Baltimore). 2025-7-11

[2]
Self-expanding metal stent as a bridge to elective surgery versus immediate emergency surgery in left-sided obstructive colorectal cancer: a retrospective comparative study.

Updates Surg. 2025-4-7

[3]
Stoma reversal after emergency stoma formation-the importance of timing: a multi-centre retrospective cohort study.

World J Emerg Surg. 2025-3-29

[4]
Pregnancy With a Stoma is Feasible, Though Associated With Manageable Complications.

Inflamm Bowel Dis. 2025-8-1

[5]
Outcomes of loop ileostomy after rectal resection for cancer: A prospective observational multicenter snapshot study from Multidisciplinary Italian Study group for STOmas (MISSTO).

Tech Coloproctol. 2024-12-11

[6]
Current approach to loop ileostomy closure: a nationwide survey on behalf of the Italian Society of ColoRectal Surgery (SICCR).

Updates Surg. 2025-1

[7]
Development and Validation of an Artificial Intelligence-Assisted Patient Education Material for Ostomy Patients: A Methodological Study.

J Adv Nurs. 2025-7

本文引用的文献

[1]
Stoma-related complications and emergencies.

Int J Emerg Med. 2022-5-9

[2]
Evidence summary for nonsurgical prevention and management of parastomal hernia in patients with enterostomy.

Am J Transl Res. 2021-11-15

[3]
A novel technique for superficial complicated stomas using the Dacron vascular prosthesis.

Langenbecks Arch Surg. 2021-6

[4]
The role of radiological classification of parastomal hernia as a predictor of the need for surgical hernia repair: a retrospective cohort study.

Langenbecks Arch Surg. 2021-8

[5]
Italian Guidelines for the Nursing Management of Enteral and Urinary Stomas in Adults: An Executive Summary.

J Wound Ostomy Continence Nurs.

[6]
Risk factors for peristomal skin disorders associated with temporary ileostomy construction.

Surg Today. 2021-7

[7]
The Use of a Stoma Rod/Bridge to Prevent Retraction: A Systematic Review.

J Wound Ostomy Continence Nurs.

[8]
Frequency and Complications of Ileostomy.

Cureus. 2020-10-29

[9]
Whether stoma support rods have application value in loop enterostomy: a systematic review and meta-analysis.

World J Surg Oncol. 2020-10-22

[10]
Surgical management of stomal prolapse - Is there a superior approach to repair?

Am J Surg. 2020-2-16

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