术前腔内支架与急诊手术治疗左半结肠和直肠癌肠梗阻的安全性与有效性Meta分析

Meta-analysis of safety and efficacy of self-expending metallic stents as bridge to surgery versusemergency surgery for left-sided malignant colorectal obstruction

目的评价术前腔内支架治疗左半结肠和直肠癌肠梗阻的安全性与有效性。方法利用CENTRAL、PubMed、EMBASE、Medline、OvidLww等英文数据库和CMB、CNKI、万方等中文数据库．全面检索术前腔内支架与急诊手术治疗左半结肠和直肠癌肠梗阻的比较研究的中英文随机对照试验和回顾性分析文献．利用RevMan5．1软件对两种治疗方法的安全性和有效性指标进行Meta分析。结果最终纳入14篇文献共1083例患者，其中随机对照研究5篇，回顾性分析9篇。与急诊手术相比，术前腔内支架组围手术期死亡率（RR：O．52；95％CI：0．30-0．93。P〈0．05）和总并发症发生率降低（RR=0．46，95％U：0．31-0．70，P〈0．01），手术切除率提高（RR：1．90，95％U：1．33-2．70，P〈0．01），手术时间（MD=-59．77，95％CI：-87．51-32．04．P〈0．01）和术后排气时间缩短（MD=一10．78，95％CI：-16．67-4．90，P〈0．01）：两种方法的永久造瘘率和住院时间的差异则无统计学意义（均P〉0．05）。结论术前腔内支架治疗左半结肠和直肠癌肠梗阻的安全性和有效性均优于急诊手术。

Objective To evaluate the safety and efficacy of self-expending metallic stents （SEMS） as bridge to surgery versus emergency surgery for left-sided malignant eolorectal obstruction. Methods A comprehensive literature search of CENTRAL, PubMed, EMBASE, Medline, Ovid LWW, CMB, CNKI and Wanfang Databases were performed for all randomized controlled trials or retrospective studies comparing self-expending metallic stents as bridge to surgery （SABS group） with emergency surgery （ES group）. A meta-analysis was carried out by RevMan5.1 software on the outcomes concerning safety and efficacy of the two groups. Results Fourteen studies matched the criteria including 1083 patients. Five were randomized controlled trials and nine were retrospective analysis. Compared with the ES group, the SABS group had a lower short-term mortality （RR=0.52, 95% CI： 0.30-0.93, P〈0.05）, lower overall complications （RR=0.46, 95% CI：0.31-0.70, P〈0.05）, higher resection rate （RR=l.90, 95%CI： 1.33-2.70, P〈0.01 ）, shorter operative time （MD=-59.77, 95%CI： - 87.51--32.04, P〈0.01）, and shorter interval to first flatus （MD=-10.78, 95%CI：-16.67--4.90, P〈 0.01 ）. There were no statistically significant differences between the two groups in permanent stomy and hospital stay. Conclusion The safety and efficacy of self-expending metallic stents as bridge to surgery for left-sided malignant colorectal obstruction is suoerior to emergencv surgery.