Kini S U, Perston Y, Radcliffe A G
Neath General Hospital, South Wales, U.K.
Surg Laparosc Endosc. 1996 Oct;6(5):371-4.
A trephined stoma allows a quick postoperative recovery when a concomitant laparotomy is not necessary. However, both colostomies and ileostomies are associated with a significant short- and long-term complication rate. Review of 25 conventional trephine colostomies showed a complication rate of 20% over 5 years (three hernias and three prolapses in five patients). A laparoscopically assisted method for trephine stoma formation is described that overcomes the disadvantages of the conventional trephine technique; namely the tendency to enlarge the trephine to mobilize the mesentery, leading to prolapse; tension on an inadequately mobilized mesentery, leading to retraction; and difficulties in the orientation of an end stoma. This method was used to fashion six colostomies and one ileostomy with no complications. There was a shorter convalescence and initial stoma care was easier. This procedure is preferred for temporary or permanent stoma formation when a laparotomy is not necessary because it allows a precise trephine mobilization of the mesentery and confirmation of orientation of the bowel.
当不需要同时进行剖腹手术时，环钻造口可使患者术后快速恢复。然而，结肠造口术和回肠造口术都伴有显著的短期和长期并发症发生率。对25例传统环钻结肠造口术的回顾显示，5年期间的并发症发生率为20%（5例患者出现3例疝和3例脱垂）。本文描述了一种腹腔镜辅助的环钻造口形成方法，该方法克服了传统环钻技术的缺点，即扩大环钻以游离肠系膜会导致脱垂；肠系膜游离不充分产生的张力会导致回缩；以及端式造口定位困难。该方法用于制作6例结肠造口术和1例回肠造口术，均无并发症发生。康复期较短，初始造口护理也更容易。当不需要剖腹手术时，该手术方法更适合用于临时或永久性造口形成，因为它能精确地通过环钻游离肠系膜并确定肠管的方向。
