Postoperative stomikomplikasjoner Mette Hammer Stomisykepleier Akershus Universitetssykehus l

Postoperative stomikomplikasjoner Mette Hammer Stomisykepleier Akershus Universitetssykehus

l Studier viser at de fleste komplikasjoner oppstår innen 2 -3 uker etter stomianleggelsen l Risikofaktorer: Stomitype, lengde, BMI, ø-hjelpsoperasjon, manglende preoperativ markering l De som var preoperativt markert hadde signifikant lavere risiko for å utvikle stomiproblemer postoperativt enn de som ikke var markert (Parmar et al 2010) l Gjennomsnittsvekten var signifikant høyere hos pasienter som fikk komplikasjoner med stomien, og gjennomsnittslengden på stomien var signifikant kortere hos de med komplikasjoner (Parmar et al 2010) Parmar et al 2010. A prospective audit of early stoma complications in colorectal cancer treatment throughout the Greater Manchester and Cheshire colorectal cancer network. The Association of Coloproctology of Great Britain and Ireland. 13, 935 -938 Persson et al 2009. Stoma-related complications and stamasize- a 2 -year follow up. The Association of Coloproctology of Great Britain and Ireland. 12, 971 -976 Shabbir, Britton 2009. Stoma complications: a literature overview. The Association of Coloproctology of Great Britain and Ireland 12, 958 -964

Mucocutan separasjon 5%-25% Observasjoner: l l Delvis eller fullstendig, overflatisk eller dyp separasjon i en mucocutan overgang Smerte/ ubehag Lyon, Smith 2010. Abdominal Stomas and their Skin Disorders. Informa Healthcare Parmar et al 2010. A prospective audit of early stoma complications in colorectal cancer treatment throughout the Greater Manchester and Cheshire colorectal cancer network. The Association of Coloproctology of Great Britain and Ireland. 13, 935 -938 Persson et al 2009. Stoma-related complications and stamasize- a 2 -year follow up. The Association of Coloproctology of Great Britain and Ireland. 12, 971 -976 Shabbir, Britton 2009. Stoma complications: a literature overview. The Association of Coloproctology of Great Britain and Ireland 12, 958 -964 3

Mucocutan separasjon Årsaker l l Kirurgisk teknikk (dårlig suturering, for stort hull i bukveggen) Nedsatt vevstilheling (ernæring, DIA, kortison, preopr. stråling) Konveksitet brukt postopr. Infeksjon Behandling l l l Fylle/ klippe utenfor defekten Såret gror godt selv med avføring i To-delt bandasje Cottam et al 2006. Results of a nationwide prospective audit of stoma complications within 3 weeks of surgery. The Association of Coloproctology of Great Britain and Ireland. 9, 834 -838 Lyon, Smith 2010. Abdominal Stomas and their Skin Disorders. Informa Healthcare 4

Nekrose l 1%-20% l Sees oftest hos de med colostomi, spesielt hvis venstre colon arterien er ligert Cottam et al 2006. Results of a nationwide prospective audit of stoma complications within 3 weeks of surgery. The Association of Coloproctology of Great Britain and Ireland. 9, 834 -838 Lyon, Smith 2010. Abdominal Stomas and their Skin Disorders. Informa Healthcare Persson et al 2009. Stoma-related complications and stamasize- a 2 -year follow up. The Association of Coloproctology of Great Britain and Ireland. 12, 971 -976 Shabbir, Britton 2009. Stoma complications: a literature overview. The Association of Coloproctology of Great Britain and Ireland 12, 958 -964

Nekrose Observasjoner: l l l Blå, svart, grå farge på slimhinnen, helt eller delvis Stomien blir tørr og ru Viktig å observere hvor dypt nekrosen går Cottam et al 2006. Results of a nationwide prospective audit of stoma complications within 3 weeks of surgery. The Association of Coloproctology of Great Britain and Ireland. 9, 834 -838 Lyon, Smith 2010. Abdominal Stomas and their Skin Disorders. Informa Healthcare 6

Nekrose Årsak l l Kirurgisk teknikk (drag i mesenteriet) Dårlig blodsirkulasjon Behandling l l Observasjon Informere lege Kirurgisk revisjon Pas. må følges opp med tanke på retraksjon eller stenose Cottam et al 2006. Results of a nationwide prospective audit of stoma complications within 3 weeks of surgery. The Association of Coloproctology of Great Britain and Ireland. 9, 834 -838 Lyon, Smith 2010. Abdominal Stomas and their Skin Disorders. Informa Healthcare Shabbir, Britton 2009. Stoma complications: a literature overview. The Association of Coloproctology of Great Britain and Ireland 12, 958 -964 7

Retrahert stomi l 10%- 40% l Retraksjon av stomien forekommer oftere hos pasienter med BMI over 21 (Shabbir et al 2009). l Hvis stomien er lavere enn 10 mm 48 t etter operasjon er det 35% sjanse for at det kan oppstå problemer (Cottam et al 2007). Arumugam et al 2003. A prospetive audit of stomas- analysis of risk factors and complications and their management. Coloretctal Disease 5, 49 -52 Cottam et al 2006. Results of a nationwide prospective audit of stoma complications within 3 weeks of surgery. The Association of Coloproctology of Great Britain and Ireland. 9, 834 -838 Lyon, Smith 2010. Abdominal Stomas and their Skin Disorders. Informa Healthcare Parmar et al 2010. A prospective audit of early stoma complications in colorectal cancer treatment throughout the Greater Manchester and Cheshire colorectal cancer network. The Association of Coloproctology of Great Britain and Ireland. 13, 935 -938 Shabbir, Britton 2009. Stoma complications: a literature overview. The Association of Coloproctology of Great Britain and Ireland 12, 958 -964

Retrahert stomi Observasjoner: l Stomien ligger i hudnivå eller under hudnivå Lyon, Smith 2010. Abdominal Stomas and their Skin Disorders. Informa Healthcare Shabbir, Britton 2009. Stoma complications: a literature overview. The Association of Coloproctology of Great Britain and Ireland 12, 958 -964 9

Retrahert stomi Årsak l l l Behandling For kort krøs For tidlig fjerning av stav i bøylestomier Kirurgisk konstruksjon Vektøkning Arrvev som følge av nekrose eller mucocutan seperasjon l l l Kirurgi En-delt bandasje evt. konveks plate Stomibelte Behandle sår hud med krystallfiolett 0, 5% og sårpulver Beskyttelsesfilm Cottam et al 2006. Results of a nationwide prospective audit of stoma complications within 3 weeks of surgery. The Association of Coloproctology of Great Britain and Ireland. 9, 834 -838 Lyon, Smith 2010. Abdominal Stomas and their Skin Disorders. Informa Healthcare 10

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