Зависит ли развитие парастомальной грыжи от способа формирования стомы? (метаанализ и систематический обзор литературы)

ЦЕЛЬ: сравнить эффективность методов профилактики парастомальных грыж.
МАТЕРИАЛЫ И МЕТОДЫ: систематический обзор и метаанализ выполнены в соответствии с практикой и рекомендациями PRISMA за весь период по 09.08.2023. Поиск научных работ проводился в электронной базе медицинской литературы PubMed (National Library of Medicine, Bethesda, MD, USA). Ключевые термины запроса: “extraperitoneal”, “transperitoneal”, “intraperitoneal”, “rectal cancer”, “abdominoperineal resection”, “parastomal hernia”, “colostomy”, “stoma”, “end colostomy”, “prophylactic mesh”, “mesh”. Из запроса были исключены исследования на животных. В результате отбора литературы в метаанализ включено 28 исследований — 15 исследований, сравнивающих формирование концевой колостомы с имплантом и без него; 5 исследований, сравнивающих внутрибрюшные и забрюшинные концевые колостомы; 8 исследований, сравнивающих формирование стомального канала через толщу прямой мышцы живота (трансректальным доступом) и латеральнее неё (параректальным доступом).
РЕЗУЛЬТАТЫ: частота парастомальных грыж достоверно ниже при формировании стомы экстраперитонеальным способом (p = 0,05) в сравнении с внутрибрюшным (ОШ = 3,40, ДИ 1,01–11,44) без достоверного увеличения частоты послеоперационных осложнений (ОШ = 1,04, ДИ 0,53–2,02, p = 0,92; ОШ = 2,22, ДИ 0,67–7,30, p = 0,19). При формировании концевой колостомы частота парастомальных грыж была достоверно ниже при применении импланта (ОШ = 1,87, ДИ 1,16–3,01, p < 0,0001) без достоверного увеличения частоты послеоперационных осложнений (ОШ = 0,93, ДИ 0,47–1,82, p = 0,82). При сравнении групп по технике формирования стомального канала параректальным и трансректальным доступом не было получено статистически значимых по частоте парастомальной грыжи (ОШ = 1,14, ДИ 0,52–2,52, p = 0,74).
ЗАКЛЮЧЕНИЕ: экстраперитонеальный способ формирования постоянных кишечных стом и применение имплантов достоверно снижает риск образования парастомальных грыж.

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