Colostomy

Japanese: 人工肛門
Colostomy

An artificial anus (stoma) is constructed when the anus or rectum is removed due to rectal cancer or to prevent intestinal contents from flowing into the lower intestinal tract.

There are various types of colostomy. Generally, they are sigmoid. colon ( Conclusion ) An artificial anus is created, Intestinal obstruction ( Super speed ) Sometimes, the sigmoid colon is constructed, Rampant ( King ) It may be the colon. It may also be a temporary construction during surgery for ulcerative colitis. ileum ( President ) There is also the option of creating an artificial anus.

The creation of an artificial anus requires careful consideration of the location of the anus, skin folds (including the navel), and surgery. Create ( yes ) Considering the wound, a position that the patient can manage by themselves should be selected. It is also necessary to choose a location that allows comfortable wearing when standing, sitting, and walking. Currently, there are specialized doctors and nurses who consider the practical aspects of colostomy, as well as specialized colostomy therapists (ETs) and specialized office staff who provide psychological support.

Orthotics

There are two types: the one-piece type, in which the part that comes into contact with the skin around the artificial anus (flange) and the bag are one unit, and the two-piece type, in which the flange and the bag are separate.

The skin-adhesive surface of the flange is made of skin-friendly materials such as Karaya rubber and Karaya paste. Buffer ( Thank you ) This product contains ingredients that have the effect of keeping the skin slightly acidic (pH 5), normalizing the skin, maintaining the skin's resistance, preventing skin infections, and protecting the skin.

Sometimes, skin rashes due to allergies or fungal dermatitis such as candida may occur on the skin. In such cases, specialist nurses such as ETs, Pressure ulcers ( Bed sores ) Appropriate management by countermeasure members is required.

Complications of colostomy

Intestinal prolapse or hernia around the artificial anus may occur. constriction ( Kyosaku ) In addition, dermatitis, skin ulcers, and the collapse of the colostomy may occur due to the insufficient height of the colostomy (distance from the skin surface). In such cases, dilation or reconstruction surgery may be necessary.

Types of colostomy (Figure 2)

1. Colostomy

There are two types of colostomy: temporary and permanent. A permanent colostomy, a single-hole sigmoid colostomy, is often created when the rectum and anus are removed due to cancer, and is usually constructed at the lower left of the navel.

There are three types of long-term management: natural defecation method, brace method, and enema method. With the natural defecation method, a cap is placed on the artificial anus at normal times, and a person may be able to develop a bowel habit (a regular lifestyle that induces the urge to defecate at a fixed time) by changing the way they eat. The brace method uses a one-piece brace (the bag is left in place and only the stool is discarded) or a two-piece brace (the flange is left in place, the bag and stool are discarded, and the bag is replaced). The enema method is a method of excreting the contents of the intestine every 1-2 days by cleaning it.

A temporary loop colostomy is constructed in the right transverse or sigmoid colon to stop the flow of intestinal contents to the lower intestine. Right transverse colostomies contain liquid intestinal contents, are more susceptible to skin irritation, and require more careful management.

② Ileostomy

When a total colectomy is performed for ulcerative colitis, etc., a temporary artificial anus is created in the ileum, and when Perforation ( flash ) In most cases, it is created temporarily to prevent stool from flowing into the intestine below the ileum due to suture failure or other reasons.

Recently, the number of cases in which an ileostomy is performed as a primary procedure to prevent anastomotic leakage after ultra-low anterior resection for rectal cancer or internal sphincterectomy (ISR) has been increasing. When an ileostomy is created, the contents of the intestine are liquid, which can easily cause dermatitis around the area, so particularly careful management is required.

Figure 2. Colostomy
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Figure 2. Colostomy


Source: Houken “Sixth Edition Family Medicine Encyclopedia” Information about the Sixth Edition Family Medicine Encyclopedia

Japanese:

 人工肛門(ストーマ)は直腸がんなどで肛門、直腸を切除する場合、または下部腸管へ腸内容が流れないようにするために造設されます。

 人工肛門のタイプはさまざまです。一般的には、S状結腸(けっちょう)人工肛門が作られますが、腸閉塞(ちょうへいそく)時に造設される場合は、S状結腸であったり、横行(おうこう)結腸であったりします。また、潰瘍性大腸炎の手術で一時的に造設される、回腸(かいちょう)人工肛門造設術などもあります。

 人工肛門の造設は、造設する部位、皮膚のしわ(へそも含めて)、手術(そう)(傷)を考えて、患者さんが自分で管理できる位置を選択します。また、立ったり、座ったり、歩いたりして装着感に問題がない部位を選ぶ必要があります。現在は、人工肛門の実際面を考える専門の医師、看護師と、精神面を援助してくれる人工肛門の専門セラピスト(ET)や専門の事務員が援助してくれます。

装具

 人工肛門の周囲の皮膚に接する部分(フランジ)と袋が一体になっているワンピース型と、フランジと袋が分かれるツーピース型とがあります。

 フランジ部分の皮膚接着面は、カラヤゴムやカラヤペーストなどの皮膚緩衝(かんしょう)作用のある材質が使われています。これは皮膚を弱酸性(pH5)に保ち、皮膚の正常化、皮膚の抵抗力の維持、皮膚感染の予防にはたらき、皮膚を保護します。

 時には、アレルギーによる皮膚炎や、皮膚にカンジダなどの真菌性皮膚炎が生じる場合があります。このような場合、ETなどの専門の看護師、褥瘡(じょくそう)対策メンバーによる適切な管理が必要になります。

人工肛門の合併症

 腸管の脱出や人工肛門の周囲からのヘルニアが生じることがあります。人工肛門の循環不全からくる狭窄(きょうさく)や、人工肛門の高さ(皮膚面からの距離)がないために起こる皮膚炎、皮膚潰瘍、人工肛門の脱落などがあり、このような場合、拡張術か再建術が必要になります。

人工肛門の種類(図2)

①結腸人工肛門

 結腸人工肛門には、一時的人工肛門と永久的人工肛門とがあります。永久的人工肛門であるS状結腸単孔式人工肛門は、多くはがんのために直腸と肛門を切除した時に作られ、通常、へその左下部に造設されます。

 長期の管理には、自然排便法、装具法、洗腸法の3種類があります。自然排便法は、普段は人工肛門にキャップをしておき、食べ方により排便習慣(規則正しい生活習慣により決まった時間に便意をもよおす)をつけられる場合があります。装具法は、ワンピース型(袋を残して便のみ捨てる)、またはツーピース型(フランジは残して袋と便を捨てたあと、袋の交換を行う)の装具を使う方法です。洗腸法は、腸内容を洗浄することにより1~2日ごとに排泄させる方法です。

 一時的なループ式の人工肛門は、下部腸管への腸内容の流れを止める目的でつくられ、右横行結腸かS状結腸に造設されます。右横行結腸人工肛門の腸内容は流動性で、皮膚炎を来しやすく、よりきめ細かな管理が必要になります。

②回腸人工肛門

 潰瘍性大腸炎など、大腸全摘手術を行った時に、一時的に回腸に人工肛門を造設する場合、および腸管の穿孔(せんこう)、縫合不全などで回腸より下部の腸管へ便が流れないようにするために一時的に造設される場合がほとんどです。

 最近では、直腸がんに対する超低位前方切除術や、内肛門括約筋切除術(ISR)といった手術が行われた場合に、縫合不全を予防するために、一次的に回腸人工肛門造設術を行う症例が増えています。回腸人工肛門を造設した場合、腸の内容物が液状で、周囲の皮膚炎を起こしやすく、とくにきめ細かい管理が必要になります。

図2 人工肛門
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図2 人工肛門


出典 法研「六訂版 家庭医学大全科」六訂版 家庭医学大全科について 情報

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