一针法回肠造口在直肠癌患者粪便转流术中应用价值的Meta分析

A Meta-Analysis of the Application Value of One-Stitch Ileostomy for Fecal Diversion among Patients with Rectal Cancer

摘要: 目的：通过与传统法回肠造口对比，系统客观地评价一针法回肠造口的应用效果。并探讨其临床应用价值。方法：系统检索万方、维普、知网、CBM、PubMed、EMbase、Web of Science以及The Cochrane Library数据库，收集自各数据库建库起至2023年11月23日期间发表的关于应用一针法回肠造口的随机对照试验(RCTs)。遵循Cochrane系统评价手册5.1.0的指导原则，我们利用RevMan 5.4软件对筛选出的文献进行了Meta分析。结果：入选RCT试验9项，患者共917例。Meta分析结果显示，一针法回肠造口应用于直肠癌粪便转流术中可以加快一期造口与二期造口还纳手术操作时间，促进术后肠道功能恢复，减少造口术后不良反应(皮肤黏膜分离)的发生率，对二期还纳术后并发症、术中出血量，患者住院时长并无显著优势。结论：一针法回肠造口应用于直肠癌粪便转流术中可提高手术效率，减少病人在手术台上时间，减少造口并发症，更快地促进术后恢复。未来仍需要更高质量的研究对本次结果进行进一步验证。

Abstract: Objective: The aim is to systematically and objectively evaluate the application effect of the one-stitch ileostomy by comparing it with the traditional ileostomy. Additionally, we aim to evaluate the effectiveness of both ileostomy methods and explore their clinical application value. Methods: We searched Wanfang, VIP, CNKI, CBM, PubMed, EMbase, Web of Science, and The Cochrane Library for randomized controlled trials (RCTs) on the use of one-stitch in temporary ileostomy, spanning from the establishment of these databases to November 23, 2023. This study included nine randomized controlled trials (RCTs), involving a total of 917 patients. A meta-analysis was performed using RevMan 5.4 software according to the Cochrane Handbook 5.1.0. Results: The results of the meta-analysis showed that the application of one-stitch ileostomy in fecal diversion for rectal cancer could shorten the operation time for both the first-stage stoma creation and the second-stage stoma closure, enhance postoperative intestinal function recovery, decrease the incidence of adverse reactions such as skin mucosa separation around the stoma, and there was no significant difference in the rates of complications, blood loss, or length of hospital stay following the second-stage stoma closure. Conclusions: The application of one-needle ileostomy in fecal diversion for rectal cancer can improve operative efficiency, decrease the duration of surgery for patients, reduce stoma complications, and facilitate faster postoperative recovery. In the future, higher-quality studies are still needed to further verify these results.