| Objective: The purpose of this study was to investigate the efficacy of extraperitoneal colostomy and intraperitoneal colostomy in Miles operation for low rectal cancer,to compare the incidence of parastomal hernia and other stoma-related complications,and to seek a more optimal stoma approach.Methods: Pub Med,Embase,Cochrane Library,China National Knowledge Infrastructure(CNKI),Wanfang Data,and China Biology Medicine(CBM)were searched for randomized controlled trials(RCTs)comparing the efficacy of colostomy by extraperitoneal and intraperitoneal routes in Miles’ surgery for rectal cancer published before March 2022.controlled trials(RCTs)or retrospective studies;all primary screening literature identified through the literature search strategy was screened by two researchers according to strict literature inclusion and exclusion criteria.The quality of the RCT literature was independently assessed according to a modified Jadad scale,and the RCT literature was also assessed for risk of bias according to the Cochrane Risk of Bias Assessment Tool.For retrospective studies,the quality of the non-randomised controlled trial literature was assessed according to the Newcastle-Ottawa Scale(NOS).Basic information and relevant study data were extracted from the final included literature and the data were statistically analysed according to the Review Manager 5.4 software provided by the Cochrane Library.Results: Totally 12 articles were included;including 4 RCT studies and 8retrospective studies.A total of 1180 patients were included,including 608 patients with extraperitoneal stoma and 572 patients with intraperitoneal stoma.Meta-analysis results showed that: the incidence of parastomal hernia in the extraperitoneal stoma group(OR=0.16,95%CI=0.09-0.27,P<0.00001);the incidence of stoma prolapse(OR=0.17,95%CI=0.07～0.42,P=0.0001<0.05);the incidence of stoma retraction(OR=0.21,95%CI=0.08 ～ 0.56,P=0.002 < 0.05);the incidence of internal hernia(OR=0.12,95%CI=0.03～0.55,P=0.006<0.05);the incidence of ostomy skin and mucous membrane separation(OR=0.31,95%CI=0.10～0.92,P=0.04<0.05)were significantly lower than those in the intraperitoneal stoma group patient.Patients in the extraperitoneal route stoma group had less intraoperative bleeding(OR=-6.36,95%CI=-10.99 ～-1.73,P=0.007 < 0.05);shorter hospital stay(OR=-0.46,95%CI=-0.70～-0.21,P=0.0003<0.05);It is easier to get the feeling of defecation after operation(OR=4.79,95%CI=2.59～8.86,P<0.00001);the incidence of mental health problems is lower(OR=0.40,95%CI=0.29～0.54,P<0.00001);the reoperation rate due to complications was lower(OR=0.33,95%CI=0.14～0.81,P=0.01<0.05);there was no significant difference in stoma time between the two groups(MD=-0.68,95%CI=-4.98 ～ 3.62,P=0.76>0.05).However,the incidence of stoma edema was higher(OR=1.65,95%CI=1.07～2.55,P=0.02<0.05).There was no significant difference in other stoma-related complications between the two groups,such as stoma ischemia or necrosis,stoma stenosis,stoma inflammation,stoma bleeding,stoma infection,first postoperative exhaust time and operation time.Conclusion: Compared with the patients in the intraperitoneal stoma group,the patients in the extraperitoneal stoma group can reduce the incidence of postoperative parastomal hernia,reduce the length of hospital stay,help the patients save hospitalization costs,promote the recovery of patients,and reduce such as: The incidence of most stoma complications,such as stoma prolapse and stoma retraction,had the same efficiency as the intraperitoneal stoma group in terms of operation time,stoma time,etc.,especially in patients with postoperative defecation sensation.In the recovery of physical and mental health,it can effectively help patients rebuild their confidence in life,reintegrate into society more quickly,and improve their quality of life. |
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