术前造口定位对肠造口患者并发症发生率影响的Meta分析OA

Objective To evaluate the effect of preoperative positioning of enterostomy on postoperative stoma-related complication rate,aiming to establish evidence-based clinical practice.Methods Relevant articles were retrieved from CNKI,Wanfang Data,VIP,CBMdisc,PubMed,Cochrane Library,CINAHL,Embase,Ovid Emcare and British Nursing Index from their establishment to June 15,2022.Subsequently,the retrieved articles underwent screening,data extraction and quality evaluation by two independent researchers and then statistical analysis using RevMan(v5.3).Results A total of 32 articles were included.The Meta-analysis showed that preoperative positioning effectively reduced the overall stoma-related complication rate[RR=0.38,95%CI(0.28,0.53),P<0.01],the peristomal skin complication rate[RR=0.47,95%CI(0.29,0.75),P<0.01],the stoma leakage rate[RR=0.20,95%CI(0.09,0.45),P<0.01,the mucocutaneous separation rate[RR=0.28,95%CI(0.13,0.61),P<0.01],the stoma retraction rate[RR=0.50,95%CI(0.27,0.92),P=0.03],the stoma stenosis rate[RR=0.27,95%CI(0.10,0.72),P<0.01],the parastomal hernia rate[RR=0.23,95%CI(0.14,0.36),P<0.01],the stoma prolapse rate[RR=0.38,95%CI(0.19,0.76),P<0.01]and the stoma bleeding rate[RR=0.26,95%CI(0.08,0.78),P=0.02].However,preoperative positioning did not significantly reduce the stoma ischemia rate[RR=0.45,95%CI(0.15,1.38),P= 0.16]and stoma edema rate.Conclusion Preoperative positioning of enterostomy can effectively reduce the overall stoma-related complication rate,the stoma/peristomal skin complication rate,parastomal hernia rate,stoma prolapse rate and stoma bleeding rate.However,there is no sufficient evidence to support its effectiveness in reducing stoma ischemia and stoma edema rates.