The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases
The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases
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DOI：
10.1007/s00384-009-0660-z
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发表时间：
2009-06-01
影响因子：
2.8
通讯作者：
Purkayastha, Sanjay
中科院分区：
文献类型：
--
作者：
Chow, Andre;Tilney, Henry S.;Purkayastha, Sanjay
袢回肠造口术目前在外科实践中用于减少结肠直肠切除术后远端吻合口衰竭的后果。人们通常认为回肠造口术的逆转是一种简单而安全的手术。然而，许多研究表明回肠造口术后的发病率很高。本系统综述的目的是检查所有现有文献中关于回肠袢造口闭合后的发病率和死亡率的证据。以Pubmed为搜索引擎，检索Ovid、Embase、Cochrane数据库、b谷歌Scholar （TM）和Medline等文献，确定有关回肠袢造口闭合发病率的研究报告（最晚于2008年6月15日）。关注的结果包括人口统计学、手术最初适应症的细节、手术和医院相关结果、术后肠道相关并发症以及其他手术和医学并发症。来自18个国家的48项研究符合纳入标准。共分析了6107例患者的结果。回肠袢造口闭合后的总发病率为17.3%，死亡率为0.4%。3.7%的患者在回肠造口闭合时需要开腹手术。最常见的术后并发症包括小肠梗阻（7.2%）和伤口败血症（5.0%）。结直肠切除术后吻合口漏的后果是严重的。然而，造口逆转的后果往往被低估。外科医生应采取选择性策略，使用功能性回肠造口术，并在原始手术前进一步咨询患者。这样，低风险的患者可以避免造口逆转的发病率。
Loop ileostomies are used currently in surgical practice to reduce the consequences of distal anastomotic failure following colorectal resection. It is often assumed that reversal of a loop ileostomy is a simple and safe procedure. However, many studies have demonstrated high morbidity rates following loop ileostomy closure. The aims of this systematic review were to examine all the existing evidence in the literature on morbidity and mortality following closure of loop ileostomy.A literature search of Ovid, Embase, the Cochrane database, Google Scholar (TM) and Medline using Pubmed as the search engine was used to identify studies reporting on the morbidity of loop ileostomy closure (latest at June 15th 2008), was performed. Outcomes of interest included demographics, the details regarding the original indication for operation, operative and hospital-related outcomes, post-operative bowel-related complications, and other surgical and medical complications.Forty-eight studies from 18 countries satisfied the inclusion criteria. Outcomes of a total of 6,107 patients were analysed. Overall morbidity following closure of loop ileostomy was found to be 17.3% with a mortality rate of 0.4%. 3.7% of patients required a laparotomy at the time of ileostomy closure. The most common post-operative complications included small bowel obstruction (7.2%) and wound sepsis (5.0%).The consequences of anastomotic leakage following colorectal resection are severe. However, the consequences of stoma reversal are often underestimated. Surgeons should adopt a selective strategy regarding the use of defunctioning ileostomy, and counsel patients further prior to the original surgery. In this way, patients at low risk may be spared the morbidity of stoma reversal.