直肠癌低位前切除术中预防性肠造瘘必要性的Meta分析

Necessity of defunctioning stoma in low anterior resection for rectal cancer： a meta-analysis

目的探讨吻合口在腹膜反折以下的直肠癌低位前切除术中预防性肠造瘘的必要性。方法检索Medline、Embase、Cochrane Library、万方和中国知网（CNKI）数据库，对符合纳入标准的文章进行Meta分析。结果6篇随机对照研究（包括648例低位直肠癌患者，其中预防性造瘘组332例．未造瘘组316例）和25篇回顾性对照研究（包括10722例低位直肠癌患者，其中预防性造瘘组4470例，未造瘘组6252例）纳入研究分析。综合分析显示，与未造瘘组比较，预防性肠造瘘能够降低术后吻合口瘘发生率（随机对照研究RR=0．33，95％CI：0．21-0．53；回顾性对照研究OR=0．60，95％CI：0．42-0．85）、吻合口瘘再手术率（随机对照研究RR=0．30，95％CI：0．16～0．53；回顾性对照研究OR=0．26：95％CI：0．21～0．32）及吻合口瘘相关死亡率（回顾性对照研究OR=0．41；95％CI：0．27～0．62）（均P〈0．05）。结论对于具有术后吻合口瘘高危因素的直肠癌患者，行低位前切除术中应常规行预防性造瘘。

Objective To evaluate the necessity of defunctioning stoma in low anterior resection for rectal cancer below peritoneal reflection. Methods The databases of Medline, Embase, Cochrane Library, Wangfang and CNKI were searched. The eligible studies were identified for pooled analyses. Results Six randomized controlled trials with 648 cases（332 patients with defunctioning stoma and 316 without stoma） and 25 retrospective controlled trials with 10,722 cases （4,470 patients with defunctioning stoma and 6,252 without stoma） were included. Combined analyses showed that defunctioning stoma was effective for decreasing risk of postoperative anastomotic leakage （RR=0.33 and 95% CI： 0.21-0.53 for RCTs, OR=0.60 and 95% CI：0.42-0.85 for retrospective studies）, reoperation （RR--0.30, 95% CI： 0.16-0.53 for RCTs, OR=0.26 and 95% CI：0.21-0.32 for retrospective studies） and mortality （OR=0.41, 95% CI： 0.27-0.62 for retrospective studies）. Conclusion Defunctioning stoma should be routinely performed in low anterior resection for high-risk patients.