Rausa Emanuele, Kelly M E, Sgroi G, Lazzari V, Aiolfi A, Cavalcoli F, Bonitta G, Bonavina L
Division of General Surgery, IRCCS Policlinico San Donato, Department of Biomedical Sciences of Health, University of Milan Medical School, San Donato Milanese, Milan, Italy.
Department of Colorectal Surgery, Connolly Hospital, Dublin, Ireland.
Int J Colorectal Dis. 2019 Feb;34(2):209-216. doi: 10.1007/s00384-018-3219-z. Epub 2018 Dec 13.
The importance of the defunctioning stoma on minimizing anastomotic leak in colorectal surgery is well established. However, a defunctioning stoma can substantially impact on quality of life (QoL). Circumferential purse-string approximation (PSA) and linear skin closure (LSC) are the most commonly performed surgical technique for reversal of stoma. The aim of this review was to systemically review and meta-analyze available randomized controlled trials (RCTs) comparing PSA and LSC.
An electronic systematic search using MEDLINE databases (PubMed, EMBASE, and Web of Science) of RCTs comparing PSA and LSC was performed. Eight RCTs totalling 647 patients met the inclusion criteria and were included in this meta-analysis.
Patient's satisfaction is significantly lower in PSA group during the first postoperative week, but it sharply improves afterwards and no difference were noted at 1 and 6 months between the two groups. Relative risk (RR) of developing a SSI is significantly lower in PSA compared to LSC group (RR 0.16 95% CI 0.09; 0.30; p = 0.0001), whereas incisional hernia (RR 0.53 95% CI 0.08; 3.53; p = 0.512), operative time (MD - 0.06 95% CI - 0.30; 0.17; p = 0.593), and hospital stay (MD - 0.09 (95% CI - 0.29-0.11; p = 0.401) remain similar.
QoL was similar in both patients groups after the first postoperative week. PSA significantly reduced SSI rate. No difference was observed in incisional hernia rate, operative time, or length of hospital stay.
在结直肠手术中，旷置造口对减少吻合口漏的重要性已得到充分证实。然而，旷置造口会对生活质量（QoL）产生重大影响。环形荷包缝合（PSA）和线性皮肤缝合（LSC）是最常用于造口回纳的手术技术。本综述的目的是系统评价和荟萃分析比较PSA和LSC的现有随机对照试验（RCT）。
使用MEDLINE数据库（PubMed、EMBASE和Web of Science）对比较PSA和LSC的RCT进行电子系统检索。八项RCT共647例患者符合纳入标准，并纳入本荟萃分析。
术后第一周，PSA组患者的满意度显著较低，但随后急剧改善，两组在1个月和6个月时无差异。与LSC组相比，PSA组发生手术部位感染（SSI）的相对风险（RR）显著更低（RR 0.16，95%CI 0.09；0.30；p = 0.0001），而切口疝（RR 0.53，95%CI 0.08；3.53；p = 0.512）、手术时间（MD -0.06，95%CI -0.30；0.17；p = 0.593）和住院时间（MD -0.09（95%CI -0.29 - 0.11；p = 0.401）保持相似。
术后第一周后，两组患者的生活质量相似。PSA显著降低了SSI发生率。在切口疝发生率、手术时间或住院时间方面未观察到差异。
