末端回肠造口早期还纳的可行性及安全性的Meta分析

The safety and efficacy of early closure of terminal ileostomy:A Meta-analysis

目的通过Meta分析来评价早期还纳末端回肠造口的可行性及安全性,为造口还纳的最佳时机提供循证医学证据。方法检索万方、中国知网、Cochrane Library、PubMed、SpringerLink、EBSCO、MEDLINE等数据库,以"末端回肠造口""早期还纳""ileostomy""early clsure""stoma""reversal"为检索词检索从2000年1月至2019年11月所有对比早期还纳及晚期还纳的文献,提取相关临床资料和数据,根据纳入和排除标准,并根据Cochrane文献质量评估手册和NOS量表评估文献质量,最后采用RevMan5.3进行Meta分析。结果最终9篇文献符合纳入标准,早期还纳组手术时间少于晚期还纳组(P=0.0005)、造口相关并发症及肠梗阻发生率低于晚期还纳组(P<0.00001),切口感染发生率高于晚期还纳组(P<0.0001),差异均有统计学意义;术后并发症(P=0.67)、术后吻合口漏发生率(P=0.39)基本相似,差异均无统计学意义。结论早期还纳末端回肠造口是安全可行的,并不增加手术并发症,且能够减少造口相关并发症,提高患者的生活质量。

Objective To evaluate the efficacy and safety of early closure of terminal ileostomy by Meta-analysis,and provide evidence for the optimal timing of closure of ileostomy.Methods The literatures comparing early closure of ileostomy with the late closure published from January 2000 to November 2019 were searched in The Wangfang,CNKI,Cochrane Library,PubMed,SpringerLink,EBSCO,MEDLINE and other databases,"ileostomy","early clsure","stoma","reversal"and other words were selected as keywords,relevant clinical data were extracted according to inclusion and exclusion criteria,the quality of literature was evaluated according to Cochrane literature quality assessment manual and NOS form,the Meta-analysis was performed by RevMan5.3.Results A total of 9 articles were included in the Meta-analysis,the duration time of the early closure group was shorter than that of late closure group(P=0.0005),the incidence of stoma related complications and intestinal obstruction was lower than that of late closure group(P<0.00001),the wound infection rate of early closure group was higher than that of late closure group,there was significant difference(P<0.0001),and there was no significant difference in postoperative complications and anastomotic leakage(P=0.67,0.39).Conclusions Early closure of terminal ileostomy is safe and feasible,does not increase the postoperative complications,and can reduce the stoma related complications,improve the patients′quality of life.