直肠癌术后预防性造口护理关键因素的Meta分析

Meta analysis on key nursing factors of preventive colostomy after rectal cancer surgery

目的分析直肠癌患者保留括约肌功能的低位前切除术后预防性造口闭合相关的风险因素。方法在PubMed、Embase、the Cochrane Library、Web of Science等生物医药数据库中检索直肠癌低位前切除术中行预防性造口的回顾性队列研究,采用Meta分析研究预防性造口闭合的风险因素。结果影响造口闭合的因素中,年龄大、ASA评分高、具有合并疾病、发生吻合口漏是造口不能闭合,成为永久性造口的风险因素。其中,年龄大的OR=16.85,95%CI[7.88,36.01],P<0.00001,I^2=86%;ASA评分高的OR=10.55,95%CI[3.46,32.18],P<0.00001,I^2=88%;具有合并疾病的OR=7.67,95%CI[1.89,31.04],P<0.00001,I^2=97%;发生吻合口漏的OR=4.53,95%CI[1.04,19.63],P<0.00001,I^2=90%。结论年龄大、ASA评分高、合并疾病以及吻合口漏的直肠癌患者行低位前切除术后易造成造口无法闭合,因此应采取积极的护理措施使患者造口得到闭合恢复。

Objective To analyze the related risk factors of preventive colostomy closure after low anterior resection of rectal cancer preserving function of sphincter. Method Search retrospective cohort studies on preventive colostomy during low anterior resection of rectal cancer in PubMed, Embase, Cochrane centre library and Web of Science. Analyze the risk factors of preventive colostomy closure by Meta analysis. Result High age, high score on ASA, complications and anastomotic leakage are risk factors of turning into permanent colostomy. For high age, OR =16.85, 95% CI [7.88, 36.01], P<0.00001, I^2 =86%. For high score on ASA, OR = 10.55, 95% CI [3.46, 32.18], P <0.00001, I^2 =88%. For complications, OR =7.67, 95% CI [1.89, 31.04], P< 0.00001 , I^2 =97%. For anastomotic leakage, OR =4.53, 95% CI [1.04, 19.63], P<0.00001, I^2 =90%. Conclusion Colostomy closure failure tend to happen on rectal cancer patients with high age, high score on ASA, complications and anastomotic leakage during low anterior resection. Positive nursing measures should be taken to help colostomy closure.