Bass E M, Del Pino A, Tan A, Pearl R K, Orsay C P, Abcarian H
Joliet Surgery and Health Care, Chicago, Illinois, USA.
Dis Colon Rectum. 1997 Apr;40(4):440-2. doi: 10.1007/BF02258389.
It is generally accepted that preoperative patient education and skin marking for a stoma location are important in avoiding stoma complications. At our institution, enterostomal therapists are available to educate and mark patients before their surgery. However, for various reasons, not all patients who had an elective stoma created, had preoperative skin marking or instructions on stoma care. Our registry of patients provided us with a means of comparing patients who have undergone an elective stoma with (Group I) and without (Group II) preoperative marking and education.
Our stoma registry consisting of 1,790 patients was retrospectively reviewed from 1978 to 1996 to assess all patients who underwent elective stoma construction. Patients included for review had a total of 593 elective stomas. All patients with stomas are followed by the enterostomal therapists postoperatively and, therefore, were evaluated for both early and late complications. Early complications were defined as any adverse event occurring within 30 days of surgery and late complications as those occurring 30 days after surgery.
Our enterostomal therapists preoperatively evaluated 292 of the 593 patients planned for possible stoma creation. This included careful marking of the stoma site by having the patients lie down, sit, and stand and locating a stable flat area on the abdomen, taking into account the belt line and any abnormal skin creases or deformities. Patients were instructed on stoma appearance with a model and given basic stoma care instructions. In Group I, there were 95 (32.5 percent) complications (68 (23.3 percent) occurred early and 27 (9.25 percent) occurred late). There were 301 patients who did not receive preoperative evaluation (Group II). In this second group, 131 (43.5 percent) complications were found, (95 (31.6 percent) occurred early and 36 (12 percent) occurred late). The difference in total number of complications between groups was determined to be statistically significant, with a P value of <0.0075, as was the difference in early complications, with a P value of <0.03. The difference in late complications is not significant, with a P value of <0.34.
These results confirm that preoperative evaluation by an enterostomal therapist, marking of the skin site, and providing patient education reduce adverse outcomes. All elective procedures that may result in stoma formation should, therefore, be assessed and marked preoperatively. Patients, likewise, should be informed and taught to care for their forthcoming stomas preoperatively and postoperatively.
术前对患者进行教育并标记造口位置对于避免造口并发症至关重要，这一点已得到广泛认可。在我们机构，造口治疗师会在患者手术前对其进行教育和标记。然而，由于各种原因，并非所有接受择期造口手术的患者都进行了术前皮肤标记或接受造口护理指导。我们的患者登记系统为我们提供了一种比较接受择期造口手术的两组患者的方法，第一组（I组）患者接受了术前标记和教育，第二组（II组）患者未接受。
我们回顾性分析了1978年至1996年期间登记的1790例患者的造口情况，以评估所有接受择期造口手术的患者。纳入研究的患者共有593个择期造口。所有造口患者术后均由造口治疗师随访，因此对早期和晚期并发症都进行了评估。早期并发症定义为手术后30天内发生的任何不良事件，晚期并发症定义为手术后30天以后发生的不良事件。
我们的造口治疗师对计划进行可能的造口手术的593例患者中的292例进行了术前评估。这包括让患者躺下、坐下和站立，仔细标记造口部位，并在腹部找到一个稳定的平坦区域，同时考虑腰带线以及任何异常的皮肤褶皱或畸形。用模型向患者说明造口外观，并给予基本的造口护理指导。I组有95例（32.5%）发生并发症（68例（23.3%）为早期并发症，27例（9.25%）为晚期并发症）。有301例患者未接受术前评估（II组）。在第二组中，发现131例（43.5%）发生并发症（95例（31.6%）为早期并发症，36例（12%）为晚期并发症）。两组并发症总数的差异具有统计学意义，P值<0.0075，早期并发症的差异也具有统计学意义，P值<0.03。晚期并发症的差异无统计学意义，P值<0.34。
这些结果证实，造口治疗师的术前评估、皮肤部位标记以及患者教育可减少不良后果。因此，所有可能导致造口形成的择期手术都应在术前进行评估和标记。同样，患者术前和术后都应被告知并学会护理即将形成的造口。
