Londono-Schimmer E E, Leong A P, Phillips R K
Department of Surgery, St. Mark's Hospital, London, United Kingdom.
Dis Colon Rectum. 1994 Sep;37(9):916-20. doi: 10.1007/BF02052598.
This study was designed to evaluate the long-term complication rate of left iliac fossa end sigmoid colostomies and to determine etiologic factors.
A retrospective chart review and actuarial analysis were performed.
The crude and actuarial risks of paracolostomy complications in 203 patients were 51.2 percent and 58.1 percent at 13 years, respectively. Paracolostomy hernia was the most common complication (36.7 percent at 10 years). Siting the stoma through the belly of the rectus abdominis muscle did not reduce the risk of hernia, but an extraperitoneal course had a significantly lower risk of herniation when compared with a transperitoneal course and intestinal obstruction was marginally less frequent. Paracolostomy hernias were otherwise more likely in the elderly, and in those with other abdominal wall hernias. Mesenteric fixation did not reduce the subsequent chance of prolapse. The reduction in the risk of intestinal obstruction when lateral space closure was employed was not statistically significant (4 percent vs. 10 percent, P < 0.1), and all three patients with stomal retraction had had lateral space closure.
The evidence in this study that spans a 22-year period questions much surgical technical dogma and raises the possibility that parastomal hernias may, like inguinal hernias, represent a failure in the transversalis fascia that might technically be avoidable.
本研究旨在评估左髂窝乙状结肠末端造口术的长期并发症发生率，并确定病因。
进行回顾性病历审查和精算分析。
203例患者结肠造口旁并发症的粗略风险和精算风险在13年时分别为51.2%和58.1%。结肠造口旁疝是最常见的并发症（10年时为36.7%）。经腹直肌肌腹定位造口并不能降低疝的风险，但与经腹腔路径相比，腹膜外路径的疝形成风险显著降低，且肠梗阻的发生率略低。结肠造口旁疝在老年人和有其他腹壁疝的患者中更常见。肠系膜固定并不能降低随后脱垂的几率。采用外侧间隙关闭术时肠梗阻风险的降低无统计学意义（4%对10%，P<0.1），且所有3例造口回缩患者均采用了外侧间隙关闭术。
这项跨越22年的研究证据对许多手术技术教条提出了质疑，并提出结肠造口旁疝可能与腹股沟疝一样，代表了腹横筋膜的缺陷，从技术上讲可能是可以避免的。
