Güenaga Katia Ferreira, Lustosa Suzana Angélica Silva, Saad Sarhan Sydney, Saconato Humberto, Matos Delcio
Division of Gastroenterology, Metropolitana University, Santos, SP, Brazil.
Acta Cir Bras. 2008 May-Jun;23(3):294-303. doi: 10.1590/s0102-86502008000300014.
The controversy regarding whether loop ileostomy or loop transverse colostomy is a better method for temporary decompression of colorectal anastomosis motivated this review.
Five randomized trials were included, with 334 patients: 168 in the loop ileostomy group and 166 in the loop transverse colostomy group. The outcomes analyzed were: 1. Mortality; 2. Wound infection; 3. Time of stoma formation; 4. Time of stoma closure; 5. Time interval between stoma formation and closure; 6. Stoma prolapse; 7. Stoma retraction; 8. Parastomal hernia; 9. Parastomal fistula; 10. Stenosis; 11. Necrosis; 12. Skin irritation; 13. Ileus; 14. Bowel leakage; 15. Reoperation; 16. Patient adaptation; 17. Length of hospital stay; 18. Colorectal anastomotic dehiscence; 19. Incisional hernia; 20. Postoperative bowel obstruction.
Stoma prolapse was statistically significant (p = 0.00001), but with statistical heterogeneity; the sensitive analysis was applied, excluding the trials that included emergency surgery, and this showed: p = 0.02, with I2 = 0% for the heterogeneity test.
The outcomes reported were not statistically or clinically significant except for stoma prolapse. Better evidence for making the choice between loop ileostomy or loop colostomy requires large-scale randomized controlled trials.
关于回肠袢式造口术或横结肠袢式造口术哪种是结直肠吻合口临时减压的更好方法存在争议，这促使了本综述的开展。
纳入五项随机试验，共334例患者：回肠袢式造口术组168例，横结肠袢式造口术组166例。分析的结局包括：1. 死亡率；2. 伤口感染；3. 造口形成时间；4. 造口关闭时间；5. 造口形成与关闭之间的时间间隔；6. 造口脱垂；7. 造口回缩；8. 造口旁疝；9. 造口旁瘘；10. 狭窄；11. 坏死；12. 皮肤刺激；13. 肠梗阻；14. 肠漏；15. 再次手术；16. 患者适应性；17. 住院时间；18. 结直肠吻合口裂开；19. 切口疝；20. 术后肠梗阻。
造口脱垂具有统计学意义（p = 0.00001），但存在统计学异质性；应用敏感性分析，排除纳入急诊手术的试验，结果显示：p = 0.02，异质性检验的I2 = 0%。
除造口脱垂外，所报告的结局在统计学或临床上均无显著意义。在回肠袢式造口术和结肠袢式造口术之间做出选择需要大规模随机对照试验提供更好的证据。
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