末端回肠造口并发症与术式优化：聚焦一针法技术

Complications and surgical optimization of terminal ileostomy: focus on the one-stitch technique

摘要:

末端回肠造口是低位直肠癌保肛手术中减轻临床吻合口漏严重程度与降低再手术率的重要策略，但其本身可引发造口周围皮肤损伤、高流量造口、造口回缩或坏死、脱垂、造口旁疝及还纳相关并发症，显著影响患者生活质量并增加医疗负担。随着直肠癌发病率上升及保肛手术比例提高，回肠造口相关并发症的规范化防治与术式优化愈发重要。近年来，在遵循造口基本原则的基础上，围绕缩短构建时间、减少皮肤黏膜分离与渗漏等目标，国内学者提出并逐步推广一针法及其改良术式，通过单点缝合完成肠袢牵出与固定，从而简化操作、减少组织损伤。本文结合国内外循证证据与指南，系统总结回肠造口及还纳等相关并发症、风险因素及防治策略，重点阐述一针法及改良术式的技术要点与临床证据，以期为回肠造口手术策略优化提供参考。

Abstract:

Terminal ileostomy is an essential strategy in sphincter-preserving surgery for low rectal cancer to reduce the severity of anastomotic leakage and reoperation rates. However, it is associated with various complications, including peristomal skin injury, high-output stoma, stoma retraction or necrosis, prolapse, parastomal hernia, and stoma reversal-related complications, which impair quality of life and increase healthcare burden. With the rising incidence of rectal cancer and increasing use of sphincter-preserving procedures, optimizing ileostomy-related management has become increasingly important. In recent years, based on fundamental principles of stoma construction, the one-stitch technique and its modifications have been proposed and gradually adopted in China to simplify procedures, shorten operative time, and reduce mucocutaneous separation, leakage and the incidence of stoma retraction by achieving loop exteriorization and fixation with a single suture. This review summarizes ileostomy- and reversal-related complications, risk factors, and management strategies, with a particular focus on the technical details and clinical evidence of the one-stitch technique, aiming to provide references for optimizing surgical strategies.