Delayed Coloanal Anastomosis Versus Immediate Coloanal Anastomosis for Low Rectal Cancer:A Meta-Analysis
贾蓉 1李权林 1张肖 1范雨诗 1李敏 1杨邦翠 1任明扬1
扫码查看
点击上方二维码区域，可以放大扫码查看
作者信息
1. 南充市中心医院胃肠外科,四川南充 637100
折叠
摘要
目的 对比低位直肠癌保肛手术采用延迟结肛吻合与一期吻合的治疗效果.方法 检索PubMed、Em-base、Web of Science、Cochrane Library、中国知网、万方数据库已公开发表的有关比较低位直肠癌保肛手术延迟结肛吻合与一期吻合近远期疗效的临床研究.提取的数据使用R4.2.0和RevMan5.3软件进行Meta分析.结果 共有14篇文献纳入汇总分析,包括2篇随机对照研究和12篇病例对照研究.总样本量为1079例.包括延迟吻合组495例,一期吻合组584例.汇总结果显示,延迟吻合组术后总体并发症(OR=0.57,95％CI 0.40～0.82,P=0.002)和术后吻合口相关并发症(OR=0.32,95％CI 0.15～0.69,P=0.003)均优于一期吻合组.两组在手术时间、术中出血量和术后1年肛门功能Wexner评分方面差异无统计学意义.结论 低位直肠癌采用延迟结肛吻合相比一期吻合+末段回肠预防性造口有利于降低总体并发症和吻合口相关并发症.因此,对于有吻合口漏高危因素的患者可以考虑采用延迟结肛吻合.
Abstract
Objective To compare the effect of delayed coloanal anastomosis versus immediate coloanal anastomosis for low rectal cancer.Methods The databases of PubMed,Embase,Web of Science,Cochrane Library,CNKI,WanFang data were searched to retrieve literature comparing delayed coloanal anastomosis with immediate coloanal anastomosis for low rectal cancer.Data was extracted and analyzed using R4.2.0 and RevMan 5.3 statistical software.Results A total of 14 articles were included,including 2 randomized controlled trials and 12 case-controlled studies,with 1079 patients in total.A total of 495 patients received delayed coloanal anastomosis and 584 patients received immediate coloanal anastomosis.The Meta analysis results showed that:the overall postoperative complication(OR=0.57,95％CI 0.40～0.82,P=0.002),postoperative anastomosis-related complication(OR=0.32,95％CI 0.15～0.69,P=0.003)in delayed anastomosis group were better than those in the immediate anastomois group.There was no statistical difference in the term of operative time,blood loss or Wexner score 1 year after surgery between the two groups.Conclusion Delayed coloanal anastomosis compared with immediate coloanal anastomosis combined with ileostomy for low rectal cancer is beneficial in reducing overall complication and anastomotic-related complications.Therefore,delayed anal anas-tomosis can be considered for patients with high risk factors for anastomotic leakage.
维普
万方数据