Najczęstsze powikłania po zabiegu kolektomii
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Najczęstsze powikłania po zabiegu kolektomii

Ten tekst przeczytasz w 2 min.

Kolektomia to zabieg chirurgiczny, który polega na całkowitym lub częściowym usunięciu okrężnicy. Analogicznie do innych operacji, operacja ta może się wiązać z wystąpieniem powikłań, takich jak krwawienie, infekcja, nieszczelność zespolenia, powikłania zakrzepowo-zatorowe czy uraz śródoperacyjny.

Kolektomię wykonuje się najczęściej w przebiegu nowotworu złośliwego, w wyniku zaostrzenia wrzodziejącego zapalenia jelita grubego oraz z powodu polipowatości rodzinnej.

Wśród wskazań do wykonania całkowitej kolektomii w trybie ostrym są:

  • perforacja jelita (przedziurawienie okrężnicy),
  • masywny krwotok,
  • megacolon toxicum,
  • zapalenie otrzewnej,
  • bardzo szybki przebieg choroby.

Operację w trybie pilnym (w ciągu 48 godz.) przeprowadza się natomiast w przypadku ciężkich rzutów colitis ulcerosa, które w okresie 5-10 dni nie poddają się intensywnemu leczeniu glukokortykosteroidami, infliximabem czy dalszemu leczeniu cyklosporyną podaną dożylnie.

Przeczytaj również: Jakie są najczęstsze objawy wrzodziejącego zapalenie jelita grubego?

Kolektomię przeprowadza się również jako operację zaplanowaną. W takich przypadkach wskazaniami są:

  • długotrwałe zaostrzenia z pogorszeniem przebiegu wrzodziejącego zapalenia jelita grubego w ciągu 12 miesięcy lub utrzymywanie się nieprzyjemnych objawów pomimo optymalnego leczenia zachowawczego,
  • stwierdzenie zmian nowotworowych lub zmian przednowotworowych (dysplazja) jelita grubego,
  • zahamowanie wzrostu z opóźnieniem dojrzewania płciowego u dzieci;
  • powikłania długotrwałej kortykoterapii,
  • powikłania miejscowe (zwężenie okrężnicy, przetoka odbytniczo-pochwowa),
  • anemia,
  • powikłania pozajelitowe (zgorzelinowe zapalenie skóry, postępujące choroby miąższu lub przewodów żółciowych wątroby, uropatia zaporowa).

Jak przygotować pacjenta do zabiegu kolektomii?

Z uwagi na to, że jelito grube zasiedla specyficzna flora bakteryjna należy wziąć pod uwagę to, iż przedostanie się jej do innych obszarów w organizmie może doprowadzić do rozwoju ciężkich powikłań. Aby tego uniknąć, przed operacją należy je dokładnie oczyścić i profilaktycznie zastosować antybiotyki.

Dodatkowo, 2 dni przed operacją szczególnie ważna jest zmiana diety, na pokarmy wyłącznie płynne. Ponadto, aby jelito zostało starannie wyczyszczone warto zastosować kilka metod, m.in. wlew doodbytniczy roztworu wody z mydłem oraz doustne środki przeczyszczające.

Jak wygląda operacja kolektomii?

Zabieg kolektomii polega na przecięciu powłok brzucha w linii pośrodkowej ciała i wycięciu fragmentu bądź całości okrężnicy. Wyróżnia się kilka rodzajów tej operacji, w zależności od rozległości i umiejscowienia wycinanego fragmentu:

  • hemikolektomia – wycięcie prawej lub lewej części jelita grubego
  • poszerzoną hemikolektomią – wycięcie dodatkowo części poprzecznej jelita
  • kolektomia totalna – wycięcie całego jelita grubego
  • sigmoidektomia – wycięcie końcowego odcinka jelita grubego (z lub bez wycięcia odbytu).

Zabieg kolektomii może się wiązać z koniecznością wyłonienia czasowego lub stałego sztucznego odbytu (stomii).

Źródło: mp.pl, Polskie Towarzystwo Wspierania Osób z Nieswoistymi Zapaleniami Jelita

 

Przeczytaj także: Czy warto stosować manualny drenaż limfatyczny w terapii ran trudno gojących się?

Przeczytaj bezpłatnie pokrewny artykuł w czasopiśmie „Forum Zakażeń”:

Znaczenie bakterii w patogenezie i przebiegu klinicznym nieswoistych chorób zapalnych jelit

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