Malik Tam, Lee M J, Harikrishnan A B
University of Sheffield , UK.
Sheffield Teaching Hospitals NHS Foundation Trust , UK.
Ann R Coll Surg Engl. 2018 Sep;100(7):501-508. doi: 10.1308/rcsann.2018.0126. Epub 2018 Aug 16.
Introduction Several stoma related complications can occur following ileostomy or colostomy formation. The reported incidence of these conditions varies widely in the literature. A systematic review of randomised controlled trials reporting the incidence of stoma related complications in adults was performed to provide the most comprehensive summary of existing data. Methods PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and the Cochrane Library were searched for trials assessing the incidence of complications in adults undergoing conventional stoma formation. Data were extracted by two independent reviewers and entered into SPSS for statistical analysis. The Cochrane Collaboration tool for assessing risk of bias was used to critically appraise each study. Cochran's Q statistic and the I statistic were used to measure the level of heterogeneity between studies. Results Overall, 18 trials were included, involving 1,009 patients. The incidence of stoma related complications ranged from 2.9% to 81.1%. Peristomal skin complications and parastomal hernia were the most common complications. End colostomy had the highest incidence of morbidity, followed by loop colostomy and loop ileostomy. There were no trials involving patients with end ileostomy. There was a high level of detection bias and heterogeneity between studies. Conclusions This systematic review has summarised the best available evidence concerning the incidence of stoma related morbidity. The high level of heterogeneity between studies has limited the accuracy with which the true incidence of each stoma related complication can be reported. Large, multicentre trials investigating homogenous participant populations are therefore required.
回肠造口术或结肠造口术形成后可能会出现几种与造口相关的并发症。这些情况在文献中报道的发生率差异很大。为了提供现有数据的最全面总结，对报告成人造口相关并发症发生率的随机对照试验进行了系统评价。方法：检索PubMed、CINAHL（护理及相关健康文献累积索引）和Cochrane图书馆，查找评估接受传统造口术成人并发症发生率的试验。由两名独立评审员提取数据，并输入SPSS进行统计分析。使用Cochrane协作网的偏倚风险评估工具对每项研究进行严格评价。采用Cochran's Q统计量和I统计量来衡量研究间的异质性水平。结果：总体纳入18项试验，涉及1009例患者。造口相关并发症的发生率在2.9%至81.1%之间。造口周围皮肤并发症和造口旁疝是最常见的并发症。末端结肠造口术的发病率最高，其次是袢式结肠造口术和袢式回肠造口术。没有涉及末端回肠造口术患者的试验。研究间存在较高水平的检测偏倚和异质性。结论：本系统评价总结了关于造口相关发病率的最佳现有证据。研究间的高度异质性限制了准确报告每种造口相关并发症真实发生率的能力。因此，需要开展针对同质受试人群的大型多中心试验。
