- 期刊
The Relationship Between Interval and Complication Rate of Closure of Intestinal Stoma
大腸造口關閉術後併發症和造口關閉時間的比較
摘要
背景及目的 大腸造口術是在大腸直腸外科常見的術式，但手術併發症卻很常見包括術後傷口感染，吻合處滲漏，腸阻塞，以及腹璧疝氣等併發症。術後併發症和許多原因有關，如手術前有無使用抗生素作大腸準備，手術方式及關閉造口時間等。本研究在於了解大腸造口關閉術後各種併發症和造口關閉時間的比較。 方法 我們收集從1990年11月到2000年2月間共206位病人（男女比165:41，年紀9歲-86歲，平均60.9歲）接受大腸造口關閉手術。病人依照造口關閉時間分成三組；第一組共有83位病人（40.3％）在三個月內接受大腸造口關閉術；第二組共有97（47.1％）位病人在三到六個月接受大腸造口關閉術；第三組共有26（12.6％）位病人在超過六個月後接受手術。這三組病人術後分別就手術時間，傷口感染，吻合處滲漏，腸阻塞及腹壁疝氣來分析統計其相互關係。 結果 就術後傷口感染而言，這三組統計起來並無統計學上的明顯差別（p = 0.098）。其他併發症如術後吻合處滲漏（p = 0.158），皮膚瘻管（p = 0.871），術後腹壁疝氣（p = 0.411），術後腸阻塞（p = 0.892），手術進行時間長短及腸切除機率都和關造口時間無統計學上差別。然而在第一組發現有較長的手術時間及較多的腸切除機率。 結論 一般認為大腸造口關閉時間，最好和上次大腸造口的時間距離六星期至三個月後。如果太早關閉造口，因此時組織較浮腫，會有較多的術後併發症。本研究顯示，大多數之大腸造口關閉的術後併發症和造口關閉時間，並無統計學上明顯差別。但太早關閉造口仍會有較長的手術時間及較高的腸切除機率，所以我們建議腸造口關閉術應在三個月後實施較適當。
並列摘要
Background and Aim. The aim of this study was to determine whether the interval of colostomy creation to closure was a factor influencing the complications of colostomy closure. Methods. A total of206 colostomies that were closed in 206 patients from December 1990 to February 2000 were reviewed. Patients were divided into 3 groups according to the interval from colostomy creation to closure: within 3 months, between 3 and 6 months, and longer than 6 months. The complication rates among groups were compared. Results. The overall complication rate was 18.9% (39 patients) and the mortality rate was O. No statistically significant difference in the rate of wound infections, anastomotic leakage, fecal fistula, incisional hernia, and intestinal obstruction was found among the 3 groups. Longer operation time and a higher bowel resection rate were noted in patients who received colostomy closure within 3 months. Conclusion. No significant differences in complication rates were found between the interval from colostomy creation to closure, but a relatively higher bowel resection rate and longer operation time was noted when colostomy was closed within 3 months. The results suggest that a temporary colostomy should not be closed less than 3 months after it is created.
延伸閱讀
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