Stoma kapatılma komplikasyonları
Stoma closure after complications
Yazar: TAMER KAN
Danışman: Y.DOÇ.DR. GÜLŞEN YILMAZ
Dicle Üniversitesi / Tıp Fakültesi / Genel Cerrahi Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2006
Konu: Genel Cerrahi = General Surgery

Özet:
ÖZETBu retrospektif çal mada klini imizde çe itli nedenlerle stoma uygulananhastalardaki stoma kapat lmas ndan sonra geli en morbidite ve mortaliteye etkilifaktörlerin ara t r lmas amaçland .Dicle Üniversitesi T p Fakültesi Genel Cerrahi Klini inde Ocak 2001-Nisan2006 y llar aras nda stoma revizyonu yap lan 147 olgu ya , cinsiyet, ostomiaç lma nedeni, ostomi tipi, yanda hastal klar, postoperatif komplikasyonlar,morbidite ve mortalite nedenleri, ostomilerin ortalama kapat lma süreleri,kapat lma s ras nda kullan lan insizyon ve kapat lma ekli, ileostomi vekolostomiler aras ndaki morbidite oran farkl l klar , hastanede kal süresi,retrospektif olarak incelendi.Verilerin analizinde SPSS 12.0 for Windows(SPSS,Inc.,Chicago,IL,USA)kullan ld . Çal maya al nan toplam 147 hasta vard . Bunlar n 104 üerkek(%70.74), 43 ü kad n idi(%29.26). Ya ortalamas 43.53 Â± 23.38 idi. Ço ustoma acil artlarda uyguland . En yayg n endikasyon intestinal perforasyondu.En s k kardiovasküler yanda hastal klar görüldü ( n:30). Stoma aç lan hastalar nortalama kapat lma süresi, stoma kapat lma insizyonu ve kapat lma ekliincelendi. Ortalama kapat lma süresi 5.03Â±2.50 ay olarak bulundu. Kapat lmainsizyonu yönünden incelendi inde, 64(%43.53) hastada median insizyon,83(%56.47) hastada da stoma insizyonu kullan larak kapat ld . Stomalar n26(%17.68) s primer sütür ile, 121(%82.32) si ise anastomoz eklinde kapat ld .Stoma kapat lmas sonras en s k görülen komplikasyonlar; yara yerienfeksiyonu, postoperatif ileus ve anostomoz kaça olarak belirlendi. Stomakapat lmas sonras nda görülen komplikasyon oran %55 idi. Stoma kapat lmasnedeniyle ameliyat s ras nda ve sonras nda görülen komplikasyonlarda, ileostomive kolostomili olgular aras nda bir farkl l k göstermedi i belirlendi. Stomakapat lmas operasyonu sonras ortalama hastanede kalma süresi 10.42Â±4.37olarak bulundu. Ya ve yanda hastal klar n morbidite ve olu ankomplikasyonlarda etkili oldu u görüldü. Mortalite oran ise %6.1 olarakbulundu. Ölüm sebebleri aras nda sepsis ve serebrovasküler emboli etkiliydi.Sonuç olarak stoma uygulanmas n n ve sonra kapat lmas n n morbiditesi vemortalitesi halen gündemdeki yerini korumaktad r. Bu yüzden özellikle ilerlemiya taki ve yanda hastal olan hastalarda yüksek morbidite ve mortalite ile34uzam hastanede kalma süresine neden oldu undan stoma açmaya kararverirken iyi dü ünmek gerekmektedir. Stoma aç lma nedenlerinin ve postoperatifsüreçte kar la lmas olas sorunlar n kapat lma sürecinde de kar m zaç kabilece i unutulmamal d r.35

Abstract:
SUMMARYIn this retrospective study, we aimed to evaluate the factors affecting onmorbidity and mortality after stoma closure in patients who undergone stoma operationforsome reasons in our clinic.147 patients who had undergone stoma revision at Dicle University MedicalFaculty, General Surgery Clinic, between January 2001 and April 2006 wereretrospectively studied according to age, gender, reason for ostomia opening, ostomiatype , related diseases, postoperative complications, reasons of morbidity and mortality,average closure periods of ostomiae, incision and type of closure, differrences betweenileostomy and colostomy according to morbidity,hospitalization period.SPSS 12.0 for Windows (SPSS,Inc., Chicago, IL, USA) was used for dataanalysis. There were 147 patients in study, of these 104were men ( 70.4% ), 43 werewomen ( 29.26% ). Mean age was 43.54 Â± 23.38. Most of the stoma procedures were inemergency conditions. The most common indications was intestinal perforation. Themost common related diseases were of cardiovascular system (n:30). We evaluatedmean closure period, closure incision and closure type in patients who had undergonestoma operation.The mean duration between construction and reverseal was 5.03 Â± 2.50months. We performed 64 (43.53%) median and 83(56.47%) stoma incision. 26 stoma(17.68% ) with primary sutures and 121 stoma (82.32.%) were closed with anastomosis.We defined that, the most commonly seen complications after stoma closurewere wound infection, postoperative ileus and anastomosis leakage. The complicationrate after stoma closure was 55%. There was no difference between the cases withileostomies and colostomies according to complications during and after the stomaclosure operation. The hospitalization period was 10.42 Â± 4.37. It was recognized thatthe age and related diseases were effective on morbidity and complications. Mortalityrate was 6.1%. Sepsis and cerebrosvascular embolia were the leading reasons.Stoma operation and its closure's morbidity and mortality are still considerable.For this reason, a surgeon should carefully decide the stoma operation because of it shigh mortality and morbidity rate especially in order patients with related diseases. Itshould always possible postoperative complications may be seen in closure period, too...36KAYNAKLAR1. Erkoçak E.U ur, Alabaz Ö., Karada A., Stoma, Alemdaro lu K., AkçalT., Bu ra D.(Ed.), Kolon Rektum ve Anal Bölge Hastal klar ,Türk Kolon veRektum Cerrahisi Derne i. 2003 stanbul , S: 307-3292. Yamaner Y.Sümer, Stoma, Stoma Komplikasyonlar ve Bak m , KalaycG.(Ed), Genel Cerrahi, Nobel T p Kitabevleri. 2002 stanbul, S: 1453-14703. Çelik F., ntestinal Stomalar, Alabaz Ö.(Ed.), Kolon ve Rektal CerrahininEl Kitab Nobel T p Kitabevleri. 2004 stanbul, S: 827-8434. Ye ilkaya Y., Kolon Ameliyatlar ve Komplikasyonlar , Sayek .(Ed),Temel Cerrahi, Güne Kitabevi.1996 Ankara, S: 1190-12005. Korkut M.Ali, Aynac M., ntestinal Stomalar( leostomi, Kolostomi),Gülay H.(Ed),Temel ve Sistematik Cerrahi, Güven Kitabevi. 2005 zmir,S: 619-16346. Duraker N, Bender Ö, Memi o lu K, Yalç ner A. ntraoperative bowelirrigation improves anastomic collagen metabolism in the left- sided colonicobstruction but not covering colostomy. Int J Colorect Dis 1998; 13: 232-47. Isbister WH, Prasad J.The management of left-sided large bowelobstruction: an audit. Aust N Z J Surg 1996; 66: 602-48. Mente B., Kolostomili ve leostomili Hastalar n Bak m na YönelikRehber Kitap, Gazi Üniversitesi T p Fakültesi Yay nlar . 2001 Ankara S:1-59. Mitchell WH, Kovalcik PJ, Cross GH. Complications of colostomyclossure . Dis Colon Rectum 1998; 21: 180-210. Foster ME, Leaper DJ, Williamson RC.Changing patterns in colostomyclosure the bristol experience, 1998-2005. Br J Surg 2005 ;72: 142-511.Pitmann DM, Smith LE. Complications of colostomy closure. Dis ColonRectum 1998; 28: 836-4312. Smit R, Walt Aj. The morbidity and cost of the temporary colostomy.Dis Colon Rectum 1998; 21: 558-6113. Wigmore SJ, Duthie GS, Young E, Spalding EM, Rainey JB.Restoration of intestinal continuity following Hartmann s procedure : theLothian experience, 1987-1992 . Br J Surg 1995; 82: 27-3014. Wara P, Sorensen K, Berg V.Proximal fecal diversion review of tenyears experience. Dis Colon Rectum 1998; 24: 114-937