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직장암 환자에서 무외번 환형 결장조루술

Loop Colostomy with Not Everted Fashion for Rectal Cancer

대한대장항문학회지 2007년 23권 1호 p.28 ~ 33
김경하, 김현태, 하태권, 신진용, 김운원, 홍관희,
소속 상세정보
김경하 ( Kim Kyung-Ha ) - 인제대학교 의과대학 부산백병원 외과학교실
김현태 ( Kim Hyun-Tae ) - 한동대학교 의과대학 선린병원 외과학교실
하태권 ( Ha Tae-Kwun ) - 인제대학교 의과대학 부산백병원 외과학교실
신진용 ( Shin Jin-Yong ) - 인제대학교 의과대학 부산백병원 외과학교실
김운원 ( Kim Woon-Won ) - 인제대학교 의과대학 부산백병원 외과학교실
홍관희 ( Hong Kwan-Hee ) - 인제대학교 의과대학 부산백병원 외과학교실

Abstract


Purpose: An anastomotic leak after resection of rectal cancer is a omnious complication. The diverting stoma is performed to avoid this serious complication. However, a diverting stoma and a stoma reversal are associated with significant morbidity and a small mortality. As stoma-related complications are associated with a delay of adjuvant therapy for advanced rectal cancer, minimal stoma-related morbidity is mandatory for rectal cancer patients. A safe and simple dissection of the stoma is known to be associated with less morbidity at stoma closure. Since in a loop colostomy of a not everted fashion, it is easy to construct and dissect the peristomal site at colostomy reversal, this study evaluated the usefulness of a protective loop colostomy of a not everted fashion in rectal cancer.

Methods: We reviewed the clinical records of 71 cases of loop colostomy closure for rectal cancer between January 1996 and December 2004. The clinical data, including indications for the stoma, the clinicopathologic features of the patients and their general conditions, the data for patients receiving adjuvant therapy, stoma-related morbidity, stoma-closure-related morbidity, and perioperative data were examined.

Results: Indications for stoma creation are the discretion of the surgeon (n=22), poor bowel preparation (n=21), unstable anastomosis (n=16), bowel obstruction (n=6), and anastomotic leakage (n=6). The stoma-related morbidity rate for a non-eversion colostomy was 5.6%. Morbidity events were peristomal erythema (n=2), prolapse (n=1), and parastomal hernia (n=1) requiring surgery. The stoma-closure-related morbidity rates was 9.9%. In the 45 patients undergoing adjuvant therapy, colostomy closure was performed during adjuvant therapy in 39 patients. Major complications, such as anastomotic leakage or abscess following reversal of the non-eversion colostomy, occurred in 1 of the 71 patients (1.4%). The average operating time and the blood loss for clostomy closure were 89.5 minutes and 202.3 ml, respectively. A simple closure of the loop colostomy was performed in 51 patients (71.8%).

Conclusion: Based on our results, a non-eversion colostomy may be considered due to the ease of construction and reversal if a temporary diverting stoma for rectal cancer is indicated. J Korean Soc Coloproctol 2007;23:28-33

키워드

결장조루술;인공항문복원술;직장암
Colostomy;Colostomy closure;Rectal cancer

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