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Article(id=1322169102727238023, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322168583854080893, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.08.023, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1748275200000, receivedDateStr=2025-05-27, revisedDate=1775059200000, revisedDateStr=2026-04-02, acceptedDate=null, acceptedDateStr=null, onlineDate=1793159278804, onlineDateStr=2026-10-28, pubDate=1777046400000, pubDateStr=2026-04-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793159278804, onlineIssueDateStr=2026-10-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793159278804, creator=13701087609, updateTime=1793159278804, updator=13701087609, issue=Issue{id=1322168583854080893, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='8', pageStart='1241', pageEnd='1424', issueExtLink='null', onlineDate='null', pubDate='1777046400000', pubDateStr='2026-04-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793159155095, creator='13701087609', updateTime=1793159155095, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1409, endPage=1413, ext={EN=ArticleExt(id=1322169104237187464, articleId=1322169102727238023, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Research progress on the prevention and management of stoma leakage in patients underwent enterostomy, columnId=1220689485315101342, journalTitle=Chinese Nursing Research, columnName=Review Articles, runingTitle=null, highlight=null, articleAbstract=

This paper systematically analyzed the causes,prevention strategies and management measures of chassis leakage in patients with enterostomy,and discussed the limitations of current research and future research directions,so as to provide scientific basis for the implementation of precise nursing work in clinical practice.

, authors=Zihan ZHAO, Chaojun XU, Mingtian LI, Yi ZHOU, Chuan LI, Yanling LIU, authorsList=Zihan ZHAO, Chaojun XU, Mingtian LI, Yi ZHOU, Chuan LI, Yanling LIU, authorCompany=null, correspAuthors=Yanling LIU, authorNote=null, correspAuthorsNote=
LIU Yanling， E-mail：
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系统分析肠造口病人发生底盘渗漏的原因、预防策略和管理措施，并探讨当前研究存在的局限性及未来研究方向，以期为临床开展精准化护理工作提供科学依据。

, authors=赵子涵, 徐朝俊, 李明天, 周怡, 李川, 刘艳玲*, *, authorsList=赵子涵, 徐朝俊, 李明天, 周怡, 李川, 刘艳玲, authorCompany=null, correspAuthors=刘艳玲, authorNote=

赵子涵，护师，硕士研究生

, correspAuthorsNote=
刘艳玲，E-mail：
LIU Yanling， E-mail：
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赵子涵，护师，硕士研究生

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赵子涵，护师，硕士研究生

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护理研究 |科研综述 2026 , 40 (8) : 1409 -1413
肠造口病人底盘渗漏预防与管理的研究进展
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赵子涵, 徐朝俊, 李明天, 周怡, 李川, 刘艳玲*, *
作者信息
  • 1中山大学肿瘤防治中心，广东 510060
通讯作者:
刘艳玲，E-mail：
LIU Yanling， E-mail：
作者简介:

赵子涵，护师，硕士研究生

Research progress on the prevention and management of stoma leakage in patients underwent enterostomy
Zihan ZHAO, Chaojun XU, Mingtian LI, Yi ZHOU, Chuan LI, Yanling LIU
Affiliations
  • 1Sun Yat-sen University Cancer Center, Guangdong 510060 China
    • Corresponding Author:
    LIU Yanling， E-mail：
出版时间: 2026-04-25 doi: 10.12102/j.issn.1009-6493.2026.08.023
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摘要
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系统分析肠造口病人发生底盘渗漏的原因、预防策略和管理措施，并探讨当前研究存在的局限性及未来研究方向，以期为临床开展精准化护理工作提供科学依据。

肠造口术  /  底盘渗漏  /  预防  /  管理  /  护理  /  综述

This paper systematically analyzed the causes,prevention strategies and management measures of chassis leakage in patients with enterostomy,and discussed the limitations of current research and future research directions,so as to provide scientific basis for the implementation of precise nursing work in clinical practice.

enterostomy  /  stoma leakage  /  prevention  /  management  /  nursing  /  review
赵子涵, 徐朝俊, 李明天, 周怡, 李川, 刘艳玲. 肠造口病人底盘渗漏预防与管理的研究进展. 护理研究, 2026 , 40 (8) : 1409 -1413 . DOI: 10.12102/j.issn.1009-6493.2026.08.023
Zihan ZHAO, Chaojun XU, Mingtian LI, Yi ZHOU, Chuan LI, Yanling LIU. Research progress on the prevention and management of stoma leakage in patients underwent enterostomy[J]. Chinese Nursing Research, 2026 , 40 (8) : 1409 -1413 . DOI: 10.12102/j.issn.1009-6493.2026.08.023
正文
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肠造口术是指通过外科手术将一段肠管拉出、开口翻转并缝合于腹壁，形成一个人工排泄口，以此替代人体原有的自然排泄功能，帮助病人排泄尿液或粪便，是维持病人生命、保证其基本生理功能的关键手段[1-2]。由于造口部位缺乏自主控制功能，病人不得不长期佩戴造口袋收集排泄物[3]。在实际生活中，由于病人对造口相关知识认知不足、术后造口周围身体形态发生变化、护理技能欠缺以及造口用品选择不恰当等因素导致造口底盘渗漏问题频发[1-4]。研究显示，高达88%的造口病人会出现不同程度的造口周围皮肤并发症，其中经历过底盘渗漏的病人比例更是达到77%[5]。造口周围皮肤长期受到底盘渗漏出的排泄物刺激，再加上所处环境潮湿、皮肤酸碱度失衡等因素，其正常的屏障功能遭到严重破坏。这不仅会引发潮湿相关性皮肤损伤、继发性感染等局部并发症，还可能导致造口旁疝等机械性损伤。同时，频繁的底盘渗漏也给病人带来了沉重的心理负担，使其更容易产生社交恐惧、焦虑、抑郁等负面情绪[6-7]。有研究表明，超过90%的造口病人会因为担忧渗漏问题而在工作与生活中遭遇困扰，这不仅严重降低了病人的生活质量，还可能进一步诱发心理疾病[8-9]。近年来，随着造口护理技术的进步与新型材料的应用，渗漏防治策略逐步完善，但个体化护理方案的精准制定仍面临诸多挑战。本研究分析国内外已有的肠造口底盘渗漏护理相关文献，旨在为建立更科学、系统的肠造口底盘渗漏管理方案提供参考。
1　底盘渗漏的定义
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肠造口作为腹部外科手术中用于转移肠道内容物的人工开口，术后病人需佩戴造口袋收集排泄物，而底盘渗漏是肠造口术后常见的护理问题，指肠造口病人肠内排泄物通过造口渗出造口器具之外的现象，对病人的生活质量产生了严重的负面影响[10]。
2　肠造口病人底盘渗漏的原因
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2.1　造口相关因素
造口及其周围身体形态相关因素是导致底盘渗漏的主要原因。1）造口位置与形态异常。庞施莲等[3]对54例底盘渗漏病人的回顾性分析显示，造口位置不当是直肠造口底盘渗漏的主要原因，如造口位于皮肤皱褶、骨突处会显著增加渗漏风险。一项回顾性分析研究指出，平坦或凹陷型造口容易导致排泄物积聚于皮肤边缘，直接加剧渗漏风险[11]。研究发现，当回肠造口高度小于2.0 cm时，几乎所有造口病人都会出现渗漏情况；当结肠造口高度小于0.5 cm时，有50%的造口病人会发生渗漏[12]。2）术后局部组织状态。研究表明，造口周围皮肤若处于瘢痕、松弛或褶皱状态，以及术后出现造口旁疝、刺激性皮炎、皮肤黏膜分离等并发症，会进一步破坏底盘的密封性，其中造口旁疝可使渗漏风险成倍增加，而黏膜分离或刺激性皮炎会因局部组织溃烂致使底盘粘贴的稳固性下降，增加渗漏风险[12-13]。
2.2　护理技术因素
肠造口底盘渗漏的发生，与病人、家属及护理人员的操作规范性与技能水平密切相关。研究显示，病人及家属在护理过程中，若存在清洁不彻底、底盘剪裁过大或形状与造口不匹配、选用的造口袋及附件产品不合适、造口袋更换不及时、造口袋过度胀满，以及未正确使用防漏膏等操作问题，会导致排泄物直接接触皮肤，或者使底盘粘贴的密封性失效，进而引发渗漏[2,4]。病人的个体差异对护理技术操作效果有着显著影响，老年病人因视力下降或手部灵活性不足，难以规范完成底盘更换流程，增加操作失误概率[4]。同时，护理知识掌握程度较低，也会削弱病人的自我管理能力，对渗漏预防效果产生明显的负面影响[1]。不过，规范化护理干预能够显著改善这一状况。韦迪等[10]开展的无漏病房规范化管理中，对照组55例肠造口病人进行常规护理；试验组55肠造口病人进行造口精准定位，开展清洁技巧、剪裁示范等系统化健康教育，以及进行更换周期控制、体位调整策略等技能指导的规范化管理；结果发现对照组渗漏率为25%，而试验组病人渗漏率降至0，充分体现了技术标准化在预防渗漏中的重要性。因此，造口治疗师等专业人员应积极开展肠造口渗漏相关知识和技能培训，提升病人及其家属的肠造口护理能力，从而减少渗漏的发生。
2.3　排泄物因素
排泄物的稀稠度是影响底盘渗漏风险的重要因素之一。研究指出，回肠造口病人的排泄物多为水样便，不仅流动性强，而且腐蚀性较高，容易绕过造口底盘边缘渗漏到周围皮肤，进而引发粪水性皮炎等并发症[14]。此外，水样排泄物在造口袋内难以均匀分布，易因重力作用积聚局部区域，增加底盘黏胶层的负荷，从而加速黏胶溶解或脱离皮肤，进一步引发渗漏。庞施莲等[3]对14例回肠造口病人底盘渗漏原因进行分析，发现排泄物为稀便合并皮肤黏膜分离是导致回肠造口底盘渗漏的最主要因素。然而，由于研究样本量较小，存在一定的局限性，未来还需要更多的研究深入探讨。
实际上，肠造口底盘渗漏往往并非由单一因素引起，而是多种因素相互作用的结果[15]，比如平坦或凹陷型造口会使排泄物在皮肤边缘积聚，而水样便因其高流动性和腐蚀性，会沿着造口边缘渗透至底盘黏胶层的薄弱区域，加速排泄物穿透防护屏障。若此时存在底盘剪裁不当、选用产品不合适以及未正确使用防漏膏等，渗漏风险会进一步加剧。多因素叠加的效应提示临床工作中，需要采用系统性风险评估工具，综合考虑造口结构、护理水平、排泄物特性等多方面因素，进而制定个性化的防漏策略，以此减少肠造口病人底盘渗漏的发生，提升病人的生活质量。
3　肠造口病人底盘渗漏的预防与管理策略
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3.1　术前规范化管理
在肠造口底盘渗漏的预防策略中，术前规范化管理是减少术后并发症的关键环节。术前管理需结合病人个体化特征，通过多学科协作优化造口定位及护理方案。世界造口治疗师协会（WCET）于2020年发布的《国际造口指南》 [16]指出，对于择期手术及可能的非择期手术，术前应由熟练的造口护士或临床医生进行造口定位，在病人分别处于站立、坐、弯腰及平躺等多种体位下对病人腹部进行全面评估，确定正确的造口位置。同时，造口定位时还应考虑病人的职业、日常状态（如坐轮椅、系腰带）、疾病情况（如需多个造口）、腹部特征（如肥胖、瘢痕、皮肤褶皱多）、文化及活动情况等，进行个性化选择，减少造口周围并发症发生。研究提示，选择腹直肌外侧平坦、无瘢痕或褶皱的皮肤区域作为造口位置，能够确保术后病人在进行日常活动时，底盘与皮肤紧密贴合，有效降低渗漏风险[17]。
同时，应开展术前健康教育提升病人及家属的护理认知水平。通过模拟操作，让病人及家属直观地了解造口护理的具体步骤和要点；进行心理疏导，缓解病人及家属对造口护理的恐惧和焦虑情绪，增强他们对造口护理的配合度，从而减少因操作不当导致的渗漏[18-19]。研究表明，开展清洁技巧、剪裁示范等系统化健康教育，以及进行更换周期控制、体位调整策略等技能指导后，试验组病人的底盘渗漏率降低，甚至实现“无渗漏病房”目标，但仅纳入55例肠造口病人，样本量不足，存在一定的局限性[10]。
3.2　术后护理优化
3.2.1　个性化产品选择
在产品选择方面，需依据造口类型和皮肤状态进行精准匹配。廖倩等[20]采取单纯随机法对165例结肠造口病人研究发现，造口周围皮肤瘢痕、褶皱、松弛下垂等不规则组织形态的病人使用微凸底盘能显著减少渗漏的发生。李长玲等[21]对1例肠外瘘病人采用丁基胶盖联合微凸底盘+造口袋进行护理，病人肠外瘘口周围无明显渗漏且刺激性接触性皮炎愈合。Rat等[22]研究显示，针对回缩或平坦造口的病人，选用凸面底盘联合加压腰带能增强造口基底与底盘的贴合度，降低渗漏的发生。孟晓红等[23]在凸面造口产品使用的国际专家共识解读中提到，除禁忌证外使用凸面底盘可有效地降低底盘渗漏的发生率，凸面底盘与皮肤接触处设计了一个弧度，保证了设备的密封性。
3.2.2　辅助产品选择
合理选择与使用辅助产品能明显降低底盘渗漏的风险。陶春南等[24]研究发现，在肠造口病人术后早期应用水胶体联合藻酸盐敷料，可以起到污物隔绝、促进生长、减轻疼痛、利于粘贴等作用，降低造口回缩、造口皮肤黏膜等并发症的发生率。一项随机对照试验指出，在造口周围使用凸面底盘和可塑密封贴环，可有效地隔绝排泄物侵蚀底盘黏胶，防止渗漏的发生[25]。另一项随机试验也指出，应用水胶体敷料建立第二平面法能够有效管理造口排泄物，减少造口袋更换及渗漏次数[26]。
3.2.3　饮食管理
Cross[27]指出，对于回肠造口病人，适当进食可溶性纤维或吸水性强的粗纤维固体食物，如红薯、叶类蔬菜等，可使排出的大便变得较稠，应尽量避免进食咖喱、菠菜、卷心菜、酒类及刺激性食物，有助于减少因腹泻而引起的底盘渗漏。
3.3　病人教育与延续性护理
3.3.1　系统化的病人教育
在病人教育中，除正确测量造口尺寸、使用防漏膏填补皮肤褶皱及选择适配的凸面或平面底盘等传统技能培训外[28]。施丽敏等[29]采用Teach-back法联合工作坊和微信指导，通过“评估→教育→复述→再评估”的循环模式，要求病人或家属复述并演示操作步骤，及时纠正认知偏差，研究证实其可使造口相关并发症发生率降低50%，但其样本量较小，结果可能存在一定的局限性。此外，病人教育应根据病人的学习能力与文化背景进行分层设计。唐文娟等[30]研究显示，文化程度较低的病人家属照护能力不足，对此可采用漫画手册、视频教育等可视化教育方式，使复杂的护理知识变得更加直观易懂。全面掌握造口护理相关知识及技能、完善造口周围皮肤自我护理能力对于病人重新适应新的生活方式至关重要[31-32]。
3.3.2　多维度的延续性护理
远程指导技术为延续护理提供了新路径，通过线上平台定期推送个性化护理方案，能够实时评估病人的渗漏风险，并指导病人调整底盘更换频率。Hao等[33]研究显示，基于互联网多联动模式的延续性护理，为病人提供系列造口相关知识和渗漏处理方法，可有效提高肠造口病人的自我效能，改善他们的不良情绪，提升生活质量。Xu等[34]研究表明，医患互动网络平台便于医生、护士与病人进行及时交流，方便指导病人处理渗漏问题，能显著缓解病人的不安情绪。此外，专科护士通过门诊随访或家庭访视，结合心理支持与多模态工具，如实物模型演示、模拟操作等，可进一步巩固病人的自我管理能力与社会适应性[35]。
3.4　多学科协作管理
肠造口渗漏的规范化管理需依托多学科协作团队模式，尤其是对于合并低蛋白血症、肠瘘或心理障碍等复杂情况的病人，需组建由造口治疗师、外科医生及营养师为核心的专业团队，根据病人个体化需求制定系统全面的干预方案。在生理层面，营养师通过精准评估病人营养状态，针对性补充蛋白质、维生素及微量元素，纠正低蛋白血症以增强造口周围组织修复能力，降低因营养不良导致的皮肤屏障脆弱性，从而减轻渗漏风险；外科医生则负责处理机械性损伤、造口回缩、黏膜分离等问题，必要时通过二次手术优化造口形态或重建支撑结构[10,36]。针对渗漏诱发的心理社会问题，团队需联合心理咨询师及病人支持小组开展工作，通过认知行为疗法，帮助病人正确认识渗漏问题，改变不良的认知模式和行为习惯；利用同伴教育的方式，让病人从有相似经历的同伴处获取经验和支持，缓解因渗漏反复发作而产生的焦虑、自卑及社交回避行为，进而提升病人的治疗依从性与自我护理效能[37-38]。在此基础上，团队需借助信息化管理平台，如底盘实时监测、线上远程指导等功能，实现渗漏风险的动态预警与居家护理的精准化调控[39-40]。
4　小结
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本研究对肠造口底盘渗漏的原因、预防策略和管理措施进行综述，底盘渗漏对病人的生活质量产生了极为不利的影响，不仅加剧了病人的社交恐惧心理，还可能引发一系列心理疾病，严重干扰病人的日常生活和心理健康。近年来，随着造口护理技术的持续进步和新型材料的广泛应用，在底盘渗漏的防治方面取得了显著成效。
然而，在肠造口底盘渗漏的预防与管理工作依旧面临着诸多挑战。首先，个体差异对护理效果的影响十分显著，不同病人的造口形态、皮肤敏感性以及生活习惯都存在较大差异，这就要求护理方案能够进一步细化分层。但目前多数指南在针对不同人群提供精准推荐方面还存在不足，难以充分满足个性化护理的需求[1]。其次，经济成本的限制，水胶体、泡沫敷料等新型功能性敷料虽能增强皮肤保护与黏附稳定性，但其高昂费用导致病人长期使用的依从性不足，尤其对低收入病人群体造成沉重的经济负担，在一定程度上限制了这些优质新型功能材料的普及应用[18]。此外，护理资源分布不均的问题较为突出。基层医院普遍缺乏造口治疗师等专科护理人员，导致规范化的护理技术难以在基层广泛普及。这使得基层医院的病人在术后出现并发症的风险明显升高，不利于整体护理水平的提升和病人的康复[10]。
建议未来的研究重点关注以下几个方向：一是加强风险预测工具的开发与验证，通过精准评估病人发生底盘渗漏的风险，为个性化护理提供更科学的依据；二是加大对造口护理专业人才的培养力度，优化护理资源的分配，提高基层护理水平；三是深入开展新型材料的临床转化研究，在保证护理效果的前提下，降低材料成本，提高性价比；四是针对特定难点开展低成本高效干预方案的比较效果研究，探索出更适合不同病人群体的经济有效的护理措施。通过制定具有针对性和有效性的防治策略及管理措施，有望减少甚至避免肠造口渗漏的发生，维持肠造口周围皮肤的健康状态，切实改善病人的生活质量。

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2026年第40卷第8期
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doi: 10.12102/j.issn.1009-6493.2026.08.023
  • 接收时间：2025-05-27
  • 首发时间：2026-10-28
  • 出版时间：2026-04-25
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  • 收稿日期：2025-05-27
  • 修回日期：2026-04-02
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    1中山大学肿瘤防治中心，广东 510060

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刘艳玲，E-mail：
LIU Yanling， E-mail：
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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