回肠造口预防直肠术后吻合口瘘作用的系统评价  

Systematic Evaluation of Effect of Ileostomy on Prevention of Anastomotic Leakage after Proctocolectomy

作　　者：赵四晖[1] 郭建辉[1] 朱军[1] 

机构地区：[1]云南省第一人民医院普外二科,云南省昆明市650032

出　　处：《中国全科医学》2012年第6期662-664,共3页Chinese General Practice

摘　　要：目的探讨回肠造口在预防直肠术后吻合口瘘方面的临床价值。方法通过计算机检索Medline、EM-Base、CENTRAL(cochrane central register of controlledtrials)、中国生物医学文献数据库系统(CBM)、中国期刊全文数据库(CNKI)、万方数据库等,收集国内外公开发表的关于回肠造口在预防直肠术后吻合口瘘方面的临床对照研究。研究对象为行直肠切除吻合术患者,干预措施为预防性回肠造口;对照组未进行回肠造口;结局指标为吻合口瘘发生的相对危险度(RR)。以RR及相应的95%可信区间(95%CI)作为效应指标对结局进行比较;各研究间的异质性采用I2检验,双侧P<0.05认为各研究间存在明显的异质性;采用Eegger法对发表偏倚进行量化检测。结果最终纳入分析的文献12篇,共1 146例患者,其中试验组523例,对照组623例。合并分析结果显示,接受预防性回肠造口者术后发生吻合口瘘的RR值为0.37[95%CI(0.23,0.58),Z=4.33,P=0.000]。结论回肠造口可以显著降低直肠术后吻合口瘘的发生风险。Objective To explore the clinical value of ileostomy in preventing anastomotic leakage after proctocolectomy.Methods By searching Medline,EMBase,CENTRAL（cochrane central register of controlledtrials）,CBM,CNKI and WANFANG,et al,we collected both domestic and overseas published clinical researches about the effect of protective ileostomy in preventing anastomotic leakage after proctocolectomy as the control trials.The subjects in the experimental group were patients receiving proctocolectomy,protective ileostomy being used as an intervention against anastomotic leakage while the patients in the control group didn′t receive protective ileostomy;and the outcome indicator was anastomotic leakage,measured by relative risk（RR）.PR and its 95% confidence interval（95%CI）were used as the effect index to compare the outcomes of the experiments.The heterogeneity between the experiments was tested by cochran′s chi-square test（Q test）and P0.05 in both sides of the body indicated that there was obvious heterogeneity among the experiments.The Eegger test was used to test the publication bias.Results 12 trials including a total of 1 146 patients were analyzed in the systematic review.523 patients were in the experimental group and 623 patients were in the control group.All the results having been combined,it was found the pooled relative risk for developing anastomotic leakage after proctocolectomy was 0.37[95%CI（0.23,0.58）,Z=4.33,P=0.000] in the experimental group,as compared with the control group.Conclusion The protective ileostomy could notably decrease the risk of developing anastomotic leakage after proctocolectomy.

关 键 词：回肠造口术 瘘 系统评价 预防 

分 类 号：R619.9[医药卫生—外科学]