Stoma Complications: The Kaohsiung Veterans General Hospital Experience

腸造口併發症－高雄榮民總醫院的經驗

金台明(Tai-Ming King) ； 王瑞和(Jui-Ho Wang) ； 陳興保(Shin-Pao Chen)

《中華民國大腸直腸外科醫學會雜誌》 16卷1期 (2005/03) Pp. 17-22

https://doi.org/10.6312/SCRSTW.2005.16(1).09402

摘要

目的　這是高雄榮民總醫院對腸造口手術的一個回溯性分析，其目的在評量不同腸段、不同類型、以及由不同科別所執行腸造口手術所發生的併發症。除此之外，我們也嘗試找尋會增加腸造口併發症的預測因子。
方法　從1991年1月到2002年12月間，有1048位病人做了1084個腸造口手術。從病歷記錄中收集病人的年齡、性別、腸造口併發症是早發生或晚發生、是否在急診情況下執行手術、執行手術醫師的專長科別、腸造口位置所在的腸段及類型、以及病人是否在手術前有腸造口治療師定位等。這些資料經由邏輯式迴歸分析以確認影響併發症發生率的變數。
結果　一共有1084個腸造口，其中78個是男性，303個是女性，年齡分佈由一天到97歲，中位數是67歲。其中617個是在急診的情況下施行，467個是在常態下施行。101個腸造口有手術前腸造口治療師定位。併發症有276個(25.5%)，其中135個(l2.5%)是早期發生（手術後一個月內），141個(13.0%)是晚期發生（手術後超過一個月）。最常見的早期併發症是皮膚刺激(5.7%)；最常見的晚期併發症依序是腸脫垂(6.4%)、造口旁疝氣(2.0%)、及皮膚刺激(1.7%)。最常發生併發症的腸造口是環狀迴腸造口(n=44,38.6%)；最少發生併發症的腸造口是末端降結腸造口(n=0)。一般外科醫師執行的腸造口手術發生最多的併發症(n=37,39.8%) ，其次依序是婦產科(n=22,37.2%)、外傷科(n=5,26.4%)、大腸直腸外科(n=202,23.6%)、及兒童外科(n=10,19.6%)。執行手術醫師的科別專長、腸造口位置所在的腸段及類型、以及是否在急診情況下執行手術等因素對腸造口併發症的發生有影響。
結論　腸造口併發症的發生很常見，不要把施行腸造口手術視爲一個小手術。因爲大多數的併發症都是可以避免的，因此術前的評估、手術技巧細節的注意、加上腸造口治療師定位衛教的協助，可以使腸造口併發症的發生減至最低。本文亦建議儘量避免施行環狀迴腸造口，在急診情況下執行腸造口手術尤其要小心仔細。

關鍵字

腸造口 ； 結腸造口 ； 迴腸造口 ； 併發症

並列摘要

Purpose. A retrospective analysis of enteric stomas performed at Kaohsiung General Hospital was undertaken to evaluate stoma complications per stoma type and configuration and operating service. In addition, we attempted to identify factors predictive of increased enteric stoma complications.
Methods. From Jan. 1991 to Dec. 2002, charts on 1048 patients with 1084 stomas were reviewed. Chart information included age, gender, early and late stoma complications, emergency status, operating service, type and configuration of the stoma, and whether the patient was seen preoperatively by an enteric stoma therapist. Data was then analyzed using a logistic regression model to identify those variables that influenced the rate of complications.
Results. Of 1084 stomas, 781 were male and 303 female. Age distribution was from I day to 97 years with a median 67 years. 617 stomas were created emergently and 467 electively. Preoperative marking was given in 101 stomas. There were 276 (25.5%) complications. Among the total complications, 135 (12.5%) occurred early (＜ I month postoperative), and 141(13.0%) occurred late (＞ 1 month). The most common early complications were skin irritation (5.7%), stoma necrosis (2.3%), and prolapse (1.6%). The most common late complications were prolapse (6.4%), parastoma hernia (2.0%), and skin irritation (1.7%). The enteric stoma with the most complications was the loop ileostomy (38.6%). The enteric stoma with the least complications was the end descending colostomy (0%). The general surgery service had the most complications (39.8%), followed by gynecology (37.2%), trauma (26.4%), colorectal (23.6%), and pediatric surgery (19.6%). Operating service, enteric stoma type and configuration, and emergency status were found to be variables that influenced stoma complications.
Conclusions. Complications from enteric stoma construction are common. Avoid the ileostomy, particularly in the loop configuration, and paying close attention to the emergency stoma construction can help minimize complications.

並列關鍵字

Enteric stomas ； Enterostoma ； Colostomy ； Ileostomy ； Complications