Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York.
Clinic of Colorectal and Minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia.
Wound Manag Prev. 2020 Jan;66(1):24-29.
A rod passed through the mesenteric window is commonly used during maturation of ileostomies, but evidence for the effectiveness of this procedure is limited.
The aim of this meta-analysis was to determine whether ileostomy rods decrease stoma retraction rates in patients undergoing loop ileostomy (LI).
The PubMed, EMBASE, Cochrane Library, MEDLINE via Ovid, Cumulative Index of Nursing and Allied Health Literature, and Web of Science databases were systematically searched for randomized controlled trials (RCT) published in English from 1990 to the present date using the MeSH terms ostomy, rod, and bridge to compare ileostomies with a rod to those without a rod. Study information, patient demographics, characteristics, and stoma retraction rates were abstracted. The primary endpoint, stoma retraction, was defined as the disappearance of normal stomal protrusion to at, or below, skin level. The Mantel-Haenszel method of meta-analysis with odds ratio and 95% confidence interval (OR [95% CI]) was used. Among-study statistical heterogeneity was assessed using Cochrane chi-squared and I² tests. Tau² analysis to assess between-study variance was employed when I² was greater than 50%. The number needed to treat/harm (NNT) was calculated to assess clinical relevance of any statistical difference. Visual assessment of funnel plots and Egger's test were used to assess for publication bias.
Of the 228 publications identified, 3 RCTs totaling 392 patients (194 LI with rod and 198 LI without rod) met the inclusion criteria for analysis. Overall bias risk was low. The stoma retraction rate was 3.1% (6/194) in patients with a rod versus 4.5% (9/198) in patients with LI without a rod at a mean follow-up of 3 months. This difference was not statistically or clinically significant (OR [95% CI] = 0.60 (0.21-1.72); P = .34; NNT = 69), with low statistical heterogeneity noted among the studies (I² = 0%).
This meta-analysis found that ileostomy rods do not decrease stoma retraction rates at 3-month follow-up. Studies examining the rate of all potential complications in patients who do and do not receive rod placement following IL are needed to help surgeons make evidence-based decisions.
本荟萃分析旨在确定在接受回肠造口术（LI）的患者中，回肠造口杆是否会降低造口回缩率。
系统检索了从 1990 年至今发表的英文随机对照试验（RCT），使用 MeSH 术语“造口术”、“杆”和“桥”，比较了有杆的回肠造口术和无杆的回肠造口术。提取研究信息、患者人口统计学、特征和造口回缩率。主要终点是造口回缩，定义为正常造口突出消失到皮肤水平或以下。使用 Mantel-Haenszel 荟萃分析方法，采用比值比和 95%置信区间（OR [95%CI]）。使用 Cochrane chi-squared 和 I² 检验评估研究间的统计异质性。当 I²大于 50%时，采用 Tau² 分析评估研究间的方差。计算需要治疗/伤害的数量（NNT），以评估任何统计学差异的临床相关性。视觉评估漏斗图和 Egger 检验用于评估发表偏倚。
在 228 篇已发表的论文中，有 3 项 RCT 共 392 名患者（194 名有杆的 LI 和 198 名无杆的 LI）符合分析纳入标准。整体偏倚风险较低。在平均随访 3 个月时，有杆的患者造口回缩率为 3.1%（6/194），无杆的患者为 4.5%（9/198）。这一差异在统计学上或临床上均无显著性（OR [95%CI] = 0.60（0.21-1.72）；P =.34；NNT = 69），且研究间存在低统计学异质性（I² = 0%）。
本荟萃分析发现，在 3 个月的随访中，回肠造口杆并不能降低造口回缩率。需要研究在接受 LI 后接受和不接受杆放置的患者中所有潜在并发症的发生率，以帮助外科医生做出基于证据的决策。
