成人高排量回肠造口发生率及影响因素的meta分析

沈圆娟; 戴正香; 李菊云; 吴晓宇; 王赛男; 王青

doi:10.16766/j.cnki.issn.1674-4152.002874

成人高排量回肠造口发生率及影响因素的meta分析

doi: 10.16766/j.cnki.issn.1674-4152.002874

沈圆娟^{1, 2},
戴正香^3, ,,
李菊云²,
吴晓宇²,
王赛男²,
王青⁴

1.
南京中医药大学护理学院，江苏南京 210000
2.
南京中医药大学附属医院消化肿瘤外科，江苏南京 210000
3.
南京中医药大学附属医院感染管理办公室，江苏南京 210000
4.
南京中医药大学附属医院普外科，江苏南京 210000

基金项目:

国家自然科学基金面上项目 82174466

详细信息

通讯作者:
戴正香，E-mail：yfy0034@njucm.edu.cn

中图分类号: R574.53
计量
- 文章访问数: 384
- HTML全文浏览量: 194
- PDF下载量: 13
- 被引次数: 0
出版历程
- 收稿日期: 2022-07-13
- 网络出版日期: 2023-04-20

Incidence and influencing factors of high-output ileostomy in adults: a meta-analysis

1.
School of Nursing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210000, China

摘要

摘要: 目的系统评价高排量回肠造口(high output ileostomy，HOI)的发生率及影响因素。方法计算机检索CBM、CNKI、WanFang Data和VIP数据库、PubMed、Web of Science、EMbase、The Cochrane Library，检索有关HOI发生影响因素的研究文献，检索时间设置为建库至2022年5月。2名研究者独立筛选文献并提取资料，采用卡斯尔-渥太华(Newcastle-Ottawa scale，NOS)量表对文献进行偏倚风险评价。采用Review Manager 5.4统计分析。结果共有9项研究纳入，得分均在7分及以上。共纳入1 844例回肠造口患者，其中393例HOI，回肠造口患者的HOI总体发生率为23%(95% CI：0.18~0.28，P < 0.001)。影响因素分析结果显示，炎性肠病(OR=16.17，95% CI：7.00~37.38，P < 0.001)、糖尿病(OR=13.69，95% CI：6.42~29.20，P < 0.001)、放化疗(OR=4.50，95% CI：1.29~15.67，P=0.020)、术后出口梗阻(OR=3.77，95% CI：1.57~9.07，P=0.003)为HOI的影响因素。结论炎性肠病、糖尿病、放化疗及术后出口梗阻为HOI的影响因素，但现有研究数量较少，多为小样本研究，此外HOI的诊断标准不一致，在一定程度上影响meta分析结果，因此上述结论尚需进一步验证。
- 高排量回肠造口 /
- 发生率 /
- 影响因素
Abstract: Objective To perform a systematic review of the incidence and influencing factors of high-output ileostomy (HOI). Methods Computer searched CBM, CNKI, WanFang Data, VIP database, PubMed, Web of Science, EMbase, and the Cochrane Library for research literature on factors affecting the occurrence of HOI. The search time was set from the establishment of the database to May 2022. Two researchers screened the literature and extracted data independently. The Newcastle-Ottawa Scale was used to evaluate the risk of bias of the literature. Statistical analysis was performed using Review Manager 5.4. Results A total of nine studies were included, all with a score of 7 or above. In addition, 1 844 patients had ileostomy, including 393 patients with HOI. The overall incidence of HOI in patients with ileostomy was 23% (95% CI: 0.18-0.28, P < 0.001). Results of influencing factor analysis showed that inflammatory bowel disease (OR=16.17, 95% CI: 7.00-37.38, P < 0.001), diabetes (OR=13.69, 95% CI: 6.42-29.20, P < 0.001), chemoradiotherapy (OR=4.50, 95% CI: 1.29-15.67, P=0.020) and postoperative outlet obstruction (OR=3.77, 95% CI: 1.57-9.07, P=0.003) were the influencing factors of HOI. Conclusion Inflammatory bowel disease, diabetes, radiotherapy, chemoradiotherapy and postoperative outlet obstruction are the influencing factors of HOI, but the number of existing studies is small, and most of them are small sample studies. In addition, the diagnostic criteria of HOI are inconsistent, which affects the results of meta-analysis to a certain extent. Therefore, the above-mentioned conclusions must be further verified.
- High-output ileostomy /
- Incidence /
- Influencing factors

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图 1 文献筛选流程图

Figure 1. Flow chart of literature screening

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图 2 HOI总体发生率森林图

Figure 2. Forest map of HOI overall incidence

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图 3 发表偏倚漏斗图

Figure 3. Funnel plot of publication bias

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表 1 纳入文献基本特征及影响因素

Table 1. Basic characteristics and influencing factors of the included literature

作者	国家	年份	研究类型	样本量(T/C)	HOI定义	影响因素	质量评价(分)
ASSAF D等^[7]	以色列	2021	病例对照	41/266	患者自我报告回肠造口输出量增加并伴有临床症状或实验室检验结果异常	(1)(2)(3)	7
BAI D X等^[8]	中国	2021	病例对照	114/380	连续2天回肠造口输出＞2 000 mL/24 h	(4)(5)(6)(7)(8)	8
HARA Y等^[9]	日本	2020	病例对照	32/71	连续2天回肠造口输出＞1 500 mL/24 h	(9)	8
NAKANISHI R等^[10]	日本	2021	病例对照	44/151	回肠造口输出量≥2 000 mL/24 h	(6)(10)(11)(12)	8
PAK J等^[11]	日本	2017	病例对照	26/34	回肠造口输出量＞1 500 mL/24 h	(5)	8
SEIFARTH C等^[12]	德国	2021	病例对照	41/255	回肠造口输出量每天超过1 000 mL，持续3 d以上	(4)(13)(14)(15)(16)	8
TAKEDA M等^[13]	日本	2019	病例对照	42/122	回肠造口输出量＞2 000 mL/24 h	(5)(9)(17)	8
VERGARA-FERNÁNDEZ O等^[14]	美国	2019	病例对照	24/78	回肠造口输出量＞1 500 mL/24 h	(4)	8
CHUN L J等^[15]	美国	2012	病例对照	29/94	回肠造口输出量＞2 000 mL/24 h	(13)(18)	7
注：T为病例组，C为对照组；影响因素如下，(1)晚期美国麻醉医师协会全身状态分级；(2)腹腔镜手术；(3)肌酐水平；(4)炎性肠病(包括克罗恩病和炎性肠病)；(5)糖尿病；(6)放化疗；(7)全结肠切除手术；(8)类固醇激素治疗；(9)出口梗阻；(10)术后Clavien-Dindo Ⅱ~Ⅳ级；(11)术后白细胞≥10 000/μL；(12)术后C-反应蛋白≥10 mg/dL；(13)年龄；(14)回肠储袋-肛管吻合手术；(15)右半结肠切除手术；(16)小肠切除手术；(17)全结直肠切除手术；(18)高血压。

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