Records from five English databases and four Chinese databases. Odds ratios (OR) and 95 % confidence intervals (CI) were used to indicate the risk of inclusion of risk factors. The non-closure stoma rate used the risk difference (RD) and 95 % CI. Risk factors were evaluated for quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).
Risk factors of non-closure stoma in patients with anterior resection of rectal cancer with temporary stoma were Age ≥60 years[OR:1.57, 95%CI(1.44,1.72)], Tumor IV stage[OR:4.21, 95%CI(2.29,7.74)], American Society of Anesthesiologists (ASA)≥3[OR:1.48, 95%CI(1.33,1.65)], Neoadjuvant chemoradiotherapy[OR:1.41, 95%CI(1.09,1.82)],Open surgery[OR:1.45, 95%CI(1.09,1.93)], Postoperative chemotherapy[OR:1.37, 95%CI(1.03,1.82)], Anastomotic leakage[OR:4.61, 95%CI(2.86, 7.44)], Local recurrence[OR:7.16, 95%CI(4.70, 10.91)]. The rate of non-closure stoma after anterior resection for rectal cancer was: 0.20, 95 % CI (0.17, 0.23). The quality of evidence for stage IV tumors and anastomotic leakage was moderate, and other risk factors were low to very low.
Risk factors of non-closure stoma in patients with anterior resection of rectal cancer with temporary stoma were Age≥60 years, Tumor IV stage, ASA≥3, Neoadjuvant chemoradiotherapy, Open surgery, Postoperative chemotherapy, Anastomotic leakage, Local recurrence, and one in five anterior resection patients with a temporary stoma fails to close.
方法:记录来自五个英文数据库和四个中文数据库。使用比值比(OR)和95%置信区间(CI)来指示纳入危险因素的风险。造口不闭合率采用风险差异(RD)和95%CI。使用建议分级评估对风险因素的证据质量进行评估,开发和评估(等级)。
结果:直肠癌前切除术伴暂时性造口患者造口未闭合的危险因素为年龄≥60岁[OR:1.57,95CI(1.44,1.72)],肿瘤IV期[OR:4.21,95CI(2.29,7.74)],美国麻醉医师协会(ASA)≥3[OR:1.48,95CI(1.33,1.65)],新辅助放化疗[OR:1.41,95CI(1.09,1.82)],开放手术[OR:1.45,95CI(1.09,1.93)],术后化疗[OR:1.37,95CI(1.03,1.82)],吻合口漏[OR:4.61,95CI(2.86,7.44)],局部复发[OR:7.16,95CI(4.70,10.91)]。直肠癌前切除术后未闭合造口的发生率为:0.20,95%CI(0.17,0.23)。IV期肿瘤和吻合口漏的证据质量中等,其他危险因素低至非常低。
结论:直肠癌前切除术合并临时造口患者造口未闭合的危险因素为年龄≥60岁,肿瘤IV期,ASA≥3,新辅助放化疗,开腹手术,术后化疗,吻合口漏,局部复发,五分之一的前切除术患者的临时造口无法关闭。