Department of General, Endoscopic and Laparoscopic Colorectal Surgery, Brighton and Sussex University Hospital NHS Trust, Brighton, UK.
Department of General, Endoscopic and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Trust, Worthing Hospital, Worthing, UK.
Colorectal Dis. 2017 Dec;19(12):1050-1057. doi: 10.1111/codi.13922.
The objective of this study was to evaluate the surgical outcomes and feasibility of early loop defunctioning ileostomy closure, within 2 weeks of index surgery, in patients undergoing distal colorectal resection.
A systematic review of the literature on published randomized controlled trials reporting the feasibility and outcomes on early vs delayed closure of loop defunctioning ileostomy in patients undergoing distal colorectal resection using the principles of meta-analysis on RevMan 5.4 statistical software was undertaken.
Four randomized, controlled trials on 446 patients evaluating the feasibility and outcomes on early vs delayed closure of loop defunctioning ileostomy in patients undergoing low colorectal resection were analysed. There were 176 patients in the early closure group and 270 patients in the delayed closure group. The risk of anastomotic leak [risk ratio 0.37 (CI: 0.10-1.42), P = 0.15], anastomotic stenosis [risk ratio 4.79 (CI: 0.23-98.47), P = 0.31] and postoperative complications [risk ratio 0.75 (CI: 0.48-1.16), P = 0.19] was similar in both groups. In addition, there was no significant difference between the groups with regard to the duration of operation [standardized mean difference -0.49 (CI: -01.09, -0.12), P = 0.12] and length of hospitalization [standardized mean difference -0.04 (CI: -0.25, -0.18), P = 0.75].
Early closure of loop defunctioning ileostomy in patients undergoing distal colorectal resection is feasible with comparable outcomes to delayed closure.
本研究旨在评估在接受结直肠远端切除术的患者中，在指数手术后 2 周内早期行回肠袢式造口还纳术的手术结果和可行性。
采用荟萃分析的原则，对发表的随机对照试验文献进行系统性综述，评估在接受结直肠远端切除术的患者中，早期与延迟行回肠袢式造口还纳术的可行性和结果。使用 RevMan 5.4 统计软件。
对 4 项关于 446 例患者的随机对照试验进行了分析，评估了在接受结直肠低位切除术的患者中，早期与延迟行回肠袢式造口还纳术的可行性和结果。早期还纳组有 176 例患者，延迟还纳组有 270 例患者。吻合口漏的风险[风险比 0.37（CI：0.10-1.42），P=0.15]、吻合口狭窄的风险[风险比 4.79（CI：0.23-98.47），P=0.31]和术后并发症的风险[风险比 0.75（CI：0.48-1.16），P=0.19]在两组之间相似。此外，两组在手术时间[标准化均数差-0.49（CI：-01.09，-0.12），P=0.12]和住院时间[标准化均数差-0.04（CI：-0.25，-0.18），P=0.75]方面无显著差异。
在接受结直肠远端切除术的患者中，早期行回肠袢式造口还纳术是可行的，其结果与延迟还纳术相当。
