Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA.
Bart's and the London School of Medicine and Dentistry, London, UK.
Colorectal Dis. 2023 Jun;25(6):1128-1134. doi: 10.1111/codi.16548. Epub 2023 Mar 25.
This study aimed to assess success, recurrence, and overall complication rates among different surgical procedures for stomal prolapse.
This study was a PRISMA-compliant systematic review. PubMed, Scopus, and Google Scholar were searched until March 2022. Studies that assessed surgical treatments of stomal prolapse in adults were included. The primary outcome was recurrence of stomal prolapse and the secondary outcome was 30-day complications. A random-effect meta-analysis was used to estimate the weighted mean rates of recurrence.
Six studies published (111 patients; 103 males) were included. 52 (46.8%) patients had end colostomies, 35 (31.5%) had loop colostomies. Seven procedures were assessed and included local stoma reconstruction (40%), stapled local repair (27%), modified Altemeier technique (10%), mesh strip repair (9%), stoma relocation (6%) redo laparotomy repair (5%), and colectomy and end ileostomy (3%). The weighted mean recurrence rate after local stoma reconstruction was 37.2% (95% CI: -1.8 to 76.3), higher than that after the stapled local repair technique (14.9%; 95% CI: 1.7-28.2). The crude recurrence rate of the modified Altemeier technique was 20%, and of stoma relocation was 66.6%. No recurrence was detected after the mesh strip technique (n = 10). The median follow-up ranged between 7 months and 2.5 years.
Several surgical techniques are available to treat stomal prolapse. Local stoma reconstruction may be associated with high rates of recurrence while the stapled local repair and modified Altemeier procedure has relatively low recurrence. Further larger studies are needed to compare the efficacy of these techniques.
本研究旨在评估不同手术方法治疗造口脱垂的成功率、复发率和总体并发症发生率。
这是一项符合 PRISMA 标准的系统评价。检索了 PubMed、Scopus 和 Google Scholar，截至 2022 年 3 月。纳入评估成人造口脱垂手术治疗的研究。主要结局是造口脱垂复发，次要结局是 30 天并发症。使用随机效应荟萃分析估计复发的加权平均率。
纳入了 6 项研究（111 例患者；103 例男性）。52 例（46.8%）患者行末端结肠造口术，35 例（31.5%）行环型结肠造口术。评估了 7 种手术方法，包括局部造口重建术（40%）、吻合器局部修复术（27%）、改良 Altemeier 技术（10%）、网片条带修复术（9%）、造口移位术（6%）、再次剖腹手术修复术（5%）和结肠切除术和末端回肠造口术（3%）。局部造口重建术后的加权平均复发率为 37.2%（95%CI：-1.8 至 76.3），高于吻合器局部修复技术（14.9%；95%CI：1.7-28.2）。改良 Altemeier 技术的粗复发率为 20%，造口移位术为 66.6%。网片条带技术无复发（n=10）。中位随访时间为 7 个月至 2.5 年。
有几种手术技术可用于治疗造口脱垂。局部造口重建可能与高复发率相关，而吻合器局部修复和改良 Altemeier 术式的复发率相对较低。需要进一步进行更大规模的研究来比较这些技术的疗效。
