摘要
目的比较结直肠吻合术后预防性回肠造口与结肠造口的并发症，探讨何种造口方式更具有优势。方法检索PubMed，Embase，The Cochrane Library数据库公开发表的比较回肠造口与结肠造口的研究和相关文献。通过采用RevMan5．0统计软件，合并及比较两者并发症，选择计算相对危险度（95％CI）作为效应尺度指标来评估这两种方式的有效性及安全性。结果5篇随机对照研究和7篇非随机对照研究符合纳入标准，共计1687例患者。随机对照研究的Meta分析结果表明回肠造口组发生造口脱垂（相对危险度0．15，95％CI：0．04～0．48，P=0．001）的风险较小，非随机对照研究的Meta分析结果显示回肠造口组发生造口脱垂（相对危险度0．26，95％C10．10～0．67，P：0．005）和由造口回纳引起切口感染（相对危险度0．28，95％CI0．15～0．52，P〈0．0001）的风险较小。对于其他并发症如吻合口瘘、造口旁疝、由造口回纳引起的肠梗阻及造口周围皮炎等，分析结果差异无统计学意义（P〉0．05）。结论两种预防性造口方式各有利弊，相对于结肠造口而言，更支持回肠造口。然而，到目前为止仍然没有足够的证据表明何种方式更具优势。因此，大样本的随机对照试验和高质量的研究需要被开展以进一步论证。
Objective To compare the complications of temporary ileostomy and temporary colostomy for colorectal anastomoses, then to evaluate which one is superior to another. Methods Studies and relevant literatures comparing temporary ileostomy with temporary colostomy for defunctioning colorectal anastomoses were searched though PubMed, Embase and the Cochrane Library. The rates of complications were pooled and compared using a meta-analysis. The risk ratios were calculated with 95% confidence intervals to evaluate the safety and efficacy of each technique. Results Five randomized controlled trials and seven non-randomized studies were included, with 1687 patients in total. The meta-analysis of the RCTs demonstrated a lower risk of stoma prolapse （ Risk ratio 0.15） in the temporary ileostomy group. Meta-analysis of the non-randomized studies showed a lower risk of stoma prolapse （ Risk ratio 0. 26） and wound infection after stoma closure （ Risk ratio O. 28 ） in the temporary ileostomy group. No other statistically significant difference was observed for complications. Conclusions Each type of de- functioning stoma has its advantages and disadvantages. The authors endorse temporary ileostomy over temporary colostomy. However, there is not a strong evidence for the superiority of one temporary stoma over another for colorectal anastomoses. Large scale RCTs and high quality studies are needed.
出处
《国际外科学杂志》
2012年第8期539-545,共7页
International Journal of Surgery
作者简介
通讯作者：王道荣，Email：daororong666@sina．com
