Gachabayov Mahir, Lee Hanjoo, Tulina Inna, Tsarkov Petr, Dong Xiang Da, Kumar Nikathan Swah, Bergamaschi Roberto
Section of Colorectal Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY.
Department of Surgery, Faculty of Preventive Medicine, Clinic of Colorectal and Minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia.
Surg Technol Int. 2019 Nov 10;35:148-152.
The aim of this meta-analysis was to determine whether double-barreled wet colostomy (DBWC) provides similar urinary tract infection rates as separate urinary and fecal diversion (SUFD) in patients undergoing pelvic exenteration.
The MEDLINE, PubMed, Cochrane Library, and Scopus databases were systematically searched by two independent researchers. The primary endpoint was the urinary tract infection rate. The Mantel-Haenszel method with odds ratios with 95% confidence intervals (OR (95%CI)) was used as an effect measure for dichotomous variables. A random-effects model was used for the meta-analysis. Statistical heterogeneity among effect estimates was evaluated using I2 and Tau2.
Three observational studies that included a total of 257 patients (159 DBWC; 98 SUFD) were included after 14 potentially eligible records were screened. Pooled urinary tract infection rates were 1.9% (3/159) in DBWC and 6.1% (6/98) in SUFD. This difference was not statistically significant [OR (95%CI) = 0.27 (0.06, 1.19); p=0.08] with low among-study heterogeneity (I2=0%).
This meta-analysis did not find a significant difference in urinary tract infection rates between DBWC and SUFD in patients undergoing total pelvic exenteration. Further clinical studies will be required to further understand the pros and cons of these procedures.
本荟萃分析的目的是确定在接受盆腔脏器清除术的患者中，双腔湿结肠造口术（DBWC）与单独的尿路和粪便改道术（SUFD）相比，是否具有相似的尿路感染率。
由两名独立研究人员系统检索MEDLINE、PubMed、Cochrane图书馆和Scopus数据库。主要终点是尿路感染率。采用Mantel-Haenszel方法，以95%置信区间的比值比（OR（95%CI））作为二分变量的效应量度。荟萃分析采用随机效应模型。使用I2和Tau2评估效应估计值之间的统计异质性。
在筛选了14条潜在符合条件的记录后，纳入了3项观察性研究，共257例患者（159例DBWC；98例SUFD）。DBWC组的合并尿路感染率为1.9%（/159），SUFD组为6.1%（6/98）。这种差异无统计学意义[OR（95%CI）=0.27（0.06，1.19）；p=0.08]，研究间异质性较低（I2=0%）。
本荟萃分析未发现接受全盆腔脏器清除术的患者中，DBWC与SUFD在尿路感染率上存在显著差异。需要进一步的临床研究来进一步了解这些手术的优缺点。
