什么是结肠造口术?

结肠造口术是通过腹部为结肠(大肠)开一个口的手术。. A colostomy may be short-term (temporary) or long-term (permanent). It's often done after bowel surgery or 受伤. Most permanent colostomies are end colostomies. 许多暂时性结肠造口术会将结肠的一侧抬高到腹部的开口处.

在结肠末端造口术中，结肠末端穿过腹壁. 然后它可以像袖口一样转到下面. 然后将结肠的边缘缝合到腹壁的皮肤上，形成一个称为造口的开口. Poop (stool) drains from the stoma into a bag or pouch attached to the abdomen. 在暂时性的环形结肠造口术中, 在结肠的一侧切开一个洞，然后缝合到腹壁上的一个匹配的洞上. 这在以后可以更容易地逆转. This is done by removing the colon from the abdominal wall. Then the holes are closed so that poop flows through the colon again.

为什么我可能需要结肠造口术?

结肠造口手术可能需要治疗几种不同的疾病和状况. 这些包括:

• 先天性缺陷，如肛门开口堵塞或缺失，称为闭锁肛门

• 憩室并发症. These are small, bulging pouches of the colon. They are common in people older than age 60. 它们会被感染(憩室炎). Or they can cause severe bleeding and need bowel surgery.

• 炎症性肠病

• 结肠或直肠的损伤

• Partial or complete intestinal or bowel 堵塞

• 直肠癌或结肠癌

• 会阴处的伤口或瘘管. A fistula is an abnormal connection between internal parts of the body. Or between an internal organ and the skin. A woman's perineum is the area between the anus and vulva. In men it is between the anus and scrotum.

If surgeons have the choice to create a temporary colostomy, they often will. 在手术前与你的医疗保健提供者谈谈，看看你的结肠造口术是永久性的还是暂时性的. 有些感染或损伤需要通过结肠造口术让下游的肠道休息，以便愈合. 然后再重新连接.

In some cases, a surgeon may need to make a permanent colostomy. 例如，如果癌症是病因，直肠必须切除，可以建议这样做. Or if there is a failure of the rectal muscles that control pooping.

从那里，它进入你的小肠，然后进入你的大肠，或结肠. 几小时或几天后, 难以消化的残留物通过肛门离开直肠的储存区域, 随着粪便. 粪便在通过上结肠的过程中通常保持松散和液体. 在那里，水被吸收. So the poop gets firmer as it nears the rectum.

The ascending colon goes up the right side of your body. The poop here is liquid and somewhat acidic, and it contains digestive enzymes. The 横向 colon goes across your upper abdomen. 降结肠和乙状结肠从身体左侧延伸到直肠. 在左冒号中, the poop becomes progressively less liquid, 减少酸性, 含有更少的酶.

结肠造口术中断结肠的位置决定了你的大便对皮肤的刺激程度. 大便液体越多，酸性越强. 在结肠造口术后保护腹部皮肤就越重要.

手术的风险是什么?

结肠造口术标志着你生活中的一个重大改变，但手术本身并不复杂. 手术会在全身麻醉下进行，所以你会处于睡眠状态，不会感到疼痛. A colostomy may be done as open surgery, with one main cut. Or it may be done laparoscopically, with several tiny cuts.

和任何手术一样, 麻醉的主要风险是呼吸问题和对药物的不良反应. A colostomy carries other surgical risks:

• 出血

• 对附近器官的损害

• 感染

手术后的风险包括:

• 结肠造口口狭窄

• Scar tissue that causes intestinal 堵塞

• 皮肤过敏

• 伤口开放

• 在切口处出现疝气

我该如何为结肠造口术做准备?

手术前, 与医疗保健提供者和造口护士讨论你的手术和术后选择. This is a nurse who is specially trained to help colostomy patients. It may also help to meet with an ostomy visitor. 这是一位做过结肠造口手术的志愿者，他可以帮助你了解如何与造口手术一起生活. And, before or after your surgery, you may want to join an ostomy support group. 你可以从美国联合造口协会或美国癌症协会找到更多关于这类组织的信息.

If the colostomy surgery is not done as an emergency procedure, 你的医疗团队会给你关于饮食和药物的具体手术指导. 如果您有疑问，请遵循所有手术指示并联系您的医疗保健提供者.

在结肠造口术中会发生什么?

这取决于你为什么需要结肠造口术, it will be made in one of four parts of the colon: ascending, 横向, 下行, 或乙状结肠.

• 横向结肠造口术. This is done on the middle section of the colon. The stoma will be somewhere across the upper abdomen. 这种手术通常是暂时的. 这通常用于憩室炎, 炎症性肠病, 癌症, 堵塞, 受伤, 或者是先天缺陷. 在横向结肠造口术中, 粪便在到达降结肠之前通过结肠口离开结肠. 你的造口可能有一个或两个开口. 一个开口是用来排泄的. 第二个可能的造口是为你的结肠静止部分通常不断产生的粘液而造口. This mucus will pass through your rectum and anus if you have only 1 stoma.

• 提升结肠造口术. This goes on the right side of your abdomen. It leaves only a short part of the colon active. 通常只有当堵塞或严重的疾病阻止结肠造口术时，才会进行结肠造口术.

• 下行结肠造口术. This goes on the lower left side of the abdomen.

• 行乙状结肠. 这是最常见的类型. It's placed a few inches lower than a 下行 colostomy.

结肠造口术后会发生什么?

You may be able to suck on ice chips on the same day as your surgery. You'll likely be given clear fluids the next day. Some people eat normally within 2 days after a colostomy.

A normal stoma is moist and pink or red colored. 当你第一次看到你的结肠造口术时，它可能看起来暗红色和肿胀，还有瘀伤. 别担心. In a few weeks, the color will lighten and bruises should disappear.

手术后覆盖结肠造口的绷带或透明袋可能与你在家里使用的类型不同. 你的结肠造口术会将结肠中的粪便排出到这个结肠造口袋或袋子中. Your poop will probably be more liquid than before surgery. 你的便便稠度也取决于你做的是什么类型的结肠造口术，以及你的结肠有多少是活跃的.

在医院里

A colostomy requires a hospital stay of about 3 days to a week. Your stay will probably be longer if the colostomy was done for an emergency. 在住院期间，你将学习如何护理结肠造口术和收集粪便的器具或袋子.

Your nurse will show you how to clean your stoma. You'll do this gently every day with warm water only after you go home. Then gently pat dry or allow the area to air dry. 别担心 if you see a little bit of blood.

Use your time in the hospital to learn how to care for your colostomy. 你需要穿紧身裤, 轻量级, drainable pouch at all times if you have an ascending or 横向 colostomy. 有许多不同类型的袋子. They vary in cost and are made from odor-resistant materials.

一些接受下行结肠造口术或乙状结肠造口术的人可以随着时间的推移学会预测他们的大便何时会移动，只有当他们预计大便会移动时才戴上袋子. 他们可能还能掌握一种叫做灌溉的过程来刺激正常的, 控制排便.

回家前, 和造口护士或其他专家谈谈，他们可以帮助你试用你需要的设备. What works best will depend on what type of colostomy you have, 你的口的长度, 你的腹部形状和结实度, 口附近有没有疤痕或褶皱, 还有你的身高和体重.

有时直肠和肛门必须通过手术切除，留下所谓的后伤口. 在医院里, you'll use dressings and pads to cover this wound. 你也可以洗坐浴. 这些都是浅层的温水浸泡. 询问你的医疗保健提供者和护士如何照顾你的后伤口，直到它愈合. 如果出现问题，请联系您的提供商.

在家里

你的(粉色)气孔周围的皮肤应该看起来像你腹部其他部位的皮肤. But due to exposure to poop, especially loose poop, the skin can get irritated. 以下是一些保护皮肤的建议:

1. Make sure your pouch and skin barrier opening are the right size.

2. 约1/3满时更换眼袋，以防止渗漏和刺激皮肤. Don't wait until your skin begins to itch and burn.

3. Remove the pouching system gently, pushing your skin away instead of pulling.

4. 尽管采取了这些措施，如果皮肤仍然受到刺激，可以使用屏障霜.

Tell your healthcare provider if you have any of these:

• Severe cramps that last more than 2 hours

• 造口阻塞或塌陷

• 口出血过多或袋中有适量的血(注意:吃甜菜会导致大便变红)

• 严重损伤或切到口

• 持续的皮肤刺激

• 持续的恶心或呕吐

• 难闻或不寻常的气味持续超过一周

• 改变你的口的大小或颜色

• 阻塞或鼓胀的气孔

• 水样便便超过5小时

• Inability to wear the pouch for 2 to 3 days without leaking

• 任何与你有关的异常情况

A good rule is to empty your pouch when it's 1/3 to 1/2 full. 在袋子漏出来之前把它换掉. Different pouching systems are made to last different lengths of time. This may be anywhere from every day to every week. 如果您需要帮助支付结肠造口用品，请咨询您的医疗保健团队，了解可用的财务资源.

结肠造口术是一个很大的改变. 这需要一些调整. Even though you can feel the pouch against your body, no one else can see it. Don’t feel the need to explain your colostomy to everyone who asks. 你想分享多少就分享多少.

For some people and their immediate family members, 结肠造口术会导致抑郁症, 焦虑, 或者自尊问题. 如果你或你的直系亲属难以适应手术，请寻求心理健康资源. A short explanation would simply be that you had abdominal surgery. Think about joining a support group to help adjust to the colostomy. Your ostomy nurse or healthcare team can provide support group resources.