国际外科学杂志
國際外科學雜誌
국제외과학잡지
INTERNATIONAL JOURNAL OF SURGERY
2013年
8期
515-519
,共5页
韩野%赵宏%郭兴坡%沈一辰
韓野%趙宏%郭興坡%瀋一辰
한야%조굉%곽흥파%침일신
结肠造口术%单腔造口%双腔造口%手术后并发症%Meta分析
結腸造口術%單腔造口%雙腔造口%手術後併髮癥%Meta分析
결장조구술%단강조구%쌍강조구%수술후병발증%Meta분석
Colostomy%End colostomy%Loop colostomy%Postoperative complications%Meta-analysis
目的 比较结直肠预防性单腔造口与双腔造口的并发症,探讨何种造口方式更具有优势.方法 检索PubMed,Springer,Embase数据库公开发表的比较结直肠损伤后单双腔造口的研究和相关文献.通过采用RevMan 5.2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 6篇回顾性研究符合纳入标准,共计1 999例患者,6篇非随机对照研究的Meta分析结果显示单腔造口组发生造口脱垂(RR:0.23,95％ CI:0.05～0.99,P=0.05)和由造口因素引起造口回缩(RR:0.21,95％ CI:0.04～0.99,P=0.05)的风险较小.对于其他并发症造口狭窄、造口旁疝及造口周围皮炎等,分析结果差异无统计学意义(P＞0.05)；但在造口缺血、坏死概率方面,双腔造口明显低于单腔造口(RR:5.08,95％ CI:1.94～13.22,P=0.009).结论 在结直肠损伤后,两种预防性造口方式各有利弊,但相对于结肠双腔造口而言,单腔造口术后并发症相对较少,更有利于患者的恢复,在严格处理造口血供的情况下,我们更支持单腔造口.
目的 比較結直腸預防性單腔造口與雙腔造口的併髮癥,探討何種造口方式更具有優勢.方法 檢索PubMed,Springer,Embase數據庫公開髮錶的比較結直腸損傷後單雙腔造口的研究和相關文獻.通過採用RevMan 5.2統計軟件,閤併及比較兩者併髮癥,選擇計算相對危險度(95％CI)作為效應呎度指標來評估這兩種方式的有效性及安全性.結果 6篇迴顧性研究符閤納入標準,共計1 999例患者,6篇非隨機對照研究的Meta分析結果顯示單腔造口組髮生造口脫垂(RR:0.23,95％ CI:0.05～0.99,P=0.05)和由造口因素引起造口迴縮(RR:0.21,95％ CI:0.04～0.99,P=0.05)的風險較小.對于其他併髮癥造口狹窄、造口徬疝及造口週圍皮炎等,分析結果差異無統計學意義(P＞0.05)；但在造口缺血、壞死概率方麵,雙腔造口明顯低于單腔造口(RR:5.08,95％ CI:1.94～13.22,P=0.009).結論 在結直腸損傷後,兩種預防性造口方式各有利弊,但相對于結腸雙腔造口而言,單腔造口術後併髮癥相對較少,更有利于患者的恢複,在嚴格處理造口血供的情況下,我們更支持單腔造口.
목적 비교결직장예방성단강조구여쌍강조구적병발증,탐토하충조구방식경구유우세.방법 검색PubMed,Springer,Embase수거고공개발표적비교결직장손상후단쌍강조구적연구화상관문헌.통과채용RevMan 5.2통계연건,합병급비교량자병발증,선택계산상대위험도(95％CI)작위효응척도지표래평고저량충방식적유효성급안전성.결과 6편회고성연구부합납입표준,공계1 999례환자,6편비수궤대조연구적Meta분석결과현시단강조구조발생조구탈수(RR:0.23,95％ CI:0.05～0.99,P=0.05)화유조구인소인기조구회축(RR:0.21,95％ CI:0.04～0.99,P=0.05)적풍험교소.대우기타병발증조구협착、조구방산급조구주위피염등,분석결과차이무통계학의의(P＞0.05)；단재조구결혈、배사개솔방면,쌍강조구명현저우단강조구(RR:5.08,95％ CI:1.94～13.22,P=0.009).결론 재결직장손상후,량충예방성조구방식각유리폐,단상대우결장쌍강조구이언,단강조구술후병발증상대교소,경유리우환자적회복,재엄격처리조구혈공적정황하,아문경지지단강조구.
Objective To compare the complications of end colostomy and loop colostomy for preventive colostomy,then to evaluate which one is superior to the other.Methods Studies and relevant literatures comparing end colostomy with loop colostomy for defunctiong colostomy were searched by PubMed,Springer and Embase 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 teachnique.Results Six nonrandomized studies were included,with 1999 patients in total.The Meta-analysis of the non-randomied studies showed a lower risk of stoma retraction (RR:0.21,95％ CI:0.04 ～ 0.99,P =0.05) and stoma prolapse (RR:0.23,95 ％ CI:0.05 ～0.99,P =0.05) in the end colostomy group,but the higher risk of ischemia and necrosis (RR:5.08,95％ CI:1.94 ～ 13.22,P =0.05).No other statistically significant difference was observed for other complications.Conclusions Each type of defuncyioning stoma has its advantages and disadvantages.The study endorses end colostomy stoma over loop colostomy.However,there is not a strong evidence for the superiority of one colostomy over another for colostomy patients.So,large scale RCTs and high quality studies are needed.
