CAJ | 학술논문

目的评价结肠襻式造口和回肠襻式造口的并发症发生风险.方法检索Medline、Embase、Cochrane Library、Google Scholar及万方数据库公开发表的比较结肠襻式造口和回肠襻式造口并发症发生风险的论文；检索文献发表时间至2011年4月15日.通过Meta分析,定量评价两者的并发症发生率,采用Z检验分析数据,采用Q检验检测异质性.结果本研究一共纳入5篇随机对照研究和8篇非随机对照研究,共有1752例研究对象.与回肠襻式造口术比较,结肠襻式造口发生造口脱垂的风险较大,差异有统计学意义(OR =3.46,95％CI为1.81～6.63,P＜0.05)；两种造口术后发生造口出血、狭窄、切口感染、造口坏死、造口周围皮炎、造口旁疝等并发症风险比较,差异无统计学意义.与回肠襻式造口回纳术比较,结肠襻式造口回纳术后发生切口感染的风险较大,差异有统计学意义(OR =3.44,95％CI为1.95～6.05,P＜0.05)；回肠襻式造口回纳术后肠梗阻的发生风险较大,差异有统计学意义(OR=0.43,95％ CI为0.20～0.91,P＜0.05)；两种造口回纳术后发生肠液漏风险比较,差异无统计学意义(P＞0.05).结论结肠襻式造口术后发生造口脱垂及回纳术后切口感染的风险较大,而回肠攀式造口回纳术后肠梗阻发生的风险较大.
목적 평개결장반식조구화회장반식조구적병발증발생풍험.방법 검색Medline、Embase、Cochrane Library、Google Scholar급만방수거고공개발표적비교결장반식조구화회장반식조구병발증발생풍험적논문；검색문헌발표시간지2011년4월15일.통과Meta분석,정량평개량자적병발증발생솔,채용Z검험분석수거,채용Q검험검측이질성.결과 본연구일공납입5편수궤대조연구화8편비수궤대조연구,공유1752례연구대상.여회장반식조구술비교,결장반식조구발생조구탈수적풍험교대,차이유통계학의의(OR =3.46,95％CI위1.81～6.63,P＜0.05)；량충조구술후발생조구출혈、협착、절구감염、조구배사、조구주위피염、조구방산등병발증풍험비교,차이무통계학의의.여회장반식조구회납술비교,결장반식조구회납술후발생절구감염적풍험교대,차이유통계학의의(OR =3.44,95％CI위1.95～6.05,P＜0.05)；회장반식조구회납술후장경조적발생풍험교대,차이유통계학의의(OR=0.43,95％ CI위0.20～0.91,P＜0.05)；량충조구회납술후발생장액루풍험비교,차이무통계학의의(P＞0.05).결론 결장반식조구술후발생조구탈수급회납술후절구감염적풍험교대,이회장반식조구회납술후장경조발생적풍험교대.
Objective To assess the risks of complications of loop colostomy and loop ileostomy.Methods The databases of Medline,Embase,Cochrane Library,Google Scholar and Wanfang were retrieved to identify the published studies comparing the advantages between loop colostomy and loop ileostomy.All the articles retrieved were published before April 15,2011.The incidence of complications was analyzed by Meta-analysis.The data were analyzed by the Z test and the heterogeneity of the data was analyzed by the Q test.Results Five randomized controlled trials and 8 non-randomized controlled trials with 1752 cases were included in the Meta-analysis.Compared with loop ileostomy,loop colostomy was associated with significantly increased risk of stoma prolapse ( OR =3.46,95％ CI:1.81-6.63,P ＜ 0.05 ).There were no significant differences in the incidences of stoma hemorrhage and stenosis,wound infection,stoma necrosis,parastoma dermatitis and hernia between patients who received loop ileostomy and those who received loop colostomy.Compared with loop ileostomy,loop colostomy was associated with increased risk of wound infection following stoma closure(OR =3.44,95％ CI:1.95-6.05,P ＜0.05).Compared with loop colostomy,loop ileostomy was associated with increased risk of postoperative bowel obstruction following stoma closure(OR =0.43,95 ％ CI:0.20-0.91,P ＜ 0.05 ).There was no significant difference in the risk of anastomotic leak between loop ileostomy and loop colostomy.Conclusion Compared with loop ileostomy,loop colostomy is associated with increased risk of stoma prolapse and wound infection after stoma closure,while a higher risk of bowel obstruction following stoma closure is observed after loop ileostomy.