CAJ | 학술논문

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RevMan 5.0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％CI 0.10～0.67,P=0.005)和由造口回纳引起切口感染(相对危险度0.28,95％ CI 0.15 ～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.
목적 비교결직장문합술후예방성회장조구여결장조구적병발증,탐토하충조구방식경구유우세.방법 검색PubMed,Embase,The Cochrane Library수거고공개발표적비교회장조구여결장조구적연구화상관문헌.통과채용RevMan 5.0통계연건,합병급비교량자병발증,선택계산상대위험도(95％CI)작위효응척도지표래평고저량충방식적유효성급안전성.결과 5편수궤대조연구화7편비수궤대조연구부합납입표준,공계1687례환자.수궤대조연구적Meta분석결과표명회장조구조발생조구탈수(상대위험도0.15,95％ CI:0.04～0.48,P=0.001)적풍험교소,비수궤대조연구적Meta분석결과현시회장조구조발생조구탈수(상대위험도0.26,95％CI 0.10～0.67,P=0.005)화유조구회납인기절구감염(상대위험도0.28,95％ CI 0.15 ～0.52,P＜0.0001)적풍험교소.대우기타병발증여문합구루、조구방산、유조구회납인기적장경조급조구주위피염등,분석결과차이무통계학의의(P＞0.05).결론 량충예방성조구방식각유리폐,상대우결장조구이언,경지지회장조구.연이,도목전위지잉연몰유족구적증거표명하충방식경구우세.인차,대양본적수궤대조시험화고질량적연구수요피개전이진일보론증.
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 0.28 ) in the temporary ileostomy group.No other statistically significant difference was observed for complications.Conclusions Each type of defunctioning 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.