Department of Surgery, Royal Alexandra Hospital, Paisley, Scotland.
Knowledge Services, NHS Greater Glasgow and Clyde, Glasgow, Scotland.
Colorectal Dis. 2023 Jul;25(7):1349-1360. doi: 10.1111/codi.16603. Epub 2023 May 19.
Elective stoma formation has a negative effect on patient quality of life (QoL), with a potential detrimental impact on body image, confidence and social functioning being shown previously. However, the impact of emergency stoma formation on QoL has been explored less frequently. This systematic review aims to synthesize all available literature exploring QoL via patient-reported outcome measures.
A search strategy was implemented on 24 November 2022 across Embase, MEDLINE, PsycInfo and the Cochrane Library database after registration on PROSPERO (CRD42022370606). Studies were included if they used a standardized patient-reported outcome measure, had more than five emergency stoma patients, age > 18 years and were fully published in English. Two of three independent researchers screened articles, extracted data and performed quality assessment using the Newcastle-Ottawa Scale and the Cochrane risk of bias tool.
In all, 1775 articles were screened, with 16 included in the systematic review. This included 1868 emergency stoma patients (men:women 0.53; median age 64.6 years) followed up for a median of 12 months. Patients who had a Hartmann's procedure for perforated diverticulitis had poorer QoL than those who underwent primary anastomosis. There was a negligible difference in QoL between those who had a colonic stent for obstructing colorectal cancer compared with those who underwent emergency stoma formation. Female sex, end stoma formation and ileostomy formation were all identified as risk factors for poorer QoL.
Patients undergoing emergency stoma surgery have marginally poorer QoL compared with those undergoing similar procedures without stoma formation. Further work is required to identify risk factors associated with this and also to compare QoL after stoma reversal.
择期造口术会对患者的生活质量（QoL）产生负面影响，先前的研究表明，这可能对身体形象、信心和社交功能产生不利影响。然而，紧急造口术对 QoL 的影响研究较少。本系统评价旨在综合所有可用的文献，通过患者报告的结果测量来探索 QoL。
在 PROSPERO（CRD42022370606）注册后，于 2022 年 11 月 24 日在 Embase、MEDLINE、PsycInfo 和 Cochrane 图书馆数据库中实施了搜索策略。如果研究使用了标准化的患者报告结局测量、有超过 5 例紧急造口患者、年龄＞18 岁且以英文全文发表，则将其纳入研究。3 位独立研究人员中的 2 位筛选文章、提取数据，并使用 Newcastle-Ottawa 量表和 Cochrane 偏倚风险工具进行质量评估。
共筛选出 1775 篇文章，其中 16 篇被纳入系统评价。这包括 1868 例接受紧急造口术的患者（男：女 0.53；中位年龄 64.6 岁），中位随访时间为 12 个月。因穿孔性憩室炎行 Hartmann 手术的患者 QoL 较行一期吻合术的患者差。因结直肠梗阻行结肠支架置入术与行紧急造口术的患者 QoL 差异可忽略不计。女性、终末造口和回肠造口术均被确定为 QoL 较差的危险因素。
与未行造口术的患者相比，行紧急造口术的患者 QoL 略差。需要进一步研究以确定与这一点相关的危险因素，并比较造口逆转后的 QoL。
