预防性造口在直肠癌低位前切除术中的应用价值

Application Value of Defunctioning Stoma in Low Anterior Resection for Rectal Cancer

目的探讨预防性造口在直肠癌低位前切除术中的应用价值。方法检索美国国立医学图书馆数据库、美国医学索引数据库、荷兰医学文摘数据库、万方数据库、中国知网全文期刊数据库和中国生物医学数据库2000年1月至2013年5月发表的关于预防性造口在直肠癌低位前切除术中应用的相关研究及文献。结果共纳入3篇随机对照研究（包括524例低位直肠癌患者,其中预防性造口组270例,未预防性造口组254例）和15篇非随机对照研究（包括9688例低位直肠癌患者,其中预防性造口组4358例,未预防性造口组5330例）。Meta分析显示,随机对照研究表明预防性造口组有较低的临床吻合口瘘率（RR=0.31,95%CI 0.18-0.52,P〈0.05）和较低的瘘后再手术率（RR=0.31,95%CI 0.17-0.59,P〈0.05）。非随机对照研究表明预防性造口组有较低的吻合口瘘率（RR=0.70,95%CI 0.50-0.98,P〈0.05）、较低的瘘后再手术率（RR=0.30,95%CI 0.18-0.49,P〈0.05）和较低的瘘后病死率（RR=0.45,95%CI 0.28-0.72,P〈0.05）。结论预防性造口可以降低直肠癌低位前切除术后吻合口瘘的发生率和瘘后再手术率,因此建议在行直肠癌低位前切除术中选择性应用预防性造口。

Objective To explore the application value of defunctioning stoma in low anterior resection for rectal cancer. Methods Studies and relevant literatures regarding the defunctioning stoma in low anterior resection for rectal cancer published from Jan. 2000 to May 2013 were searched in Pub Med,Medline,EMbase,Wanfang,CNKI and CBM and analyzed. Results Three RCTs with 524 cases（ 270 patients with defunctioning stoma and 254 without stoma） and 15 non-randomized studies with 9688 cases（ 4358 patients with defunctioning stoma and 5330 without stoma） were included in the study. Meta-analysis results of the RCTs showed a lower clinical anastomotic leak rate（ RR = 0. 31,95% CI： 0. 18-0. 52,P 0. 05） and a lower reoperation rate（ RR = 0. 31,95% CI： 0. 17-0. 59,P 0. 05） in the defunctioning stoma group. Meta-analysis results of the non-randomized studies showed a lower clinical anastomotic leak rate（ RR = 0. 70,95% CI 0. 50-0. 98,P 0. 05）,lower reoperation rate（ RR = 0. 30,95% CI 0. 18-0. 49,P 0. 05） and lower mortality rate（ RR = 0. 45,95% CI 0. 28-0. 72,P 0. 05） in the defunctioning stoma group. Conclusion Defunctioning stoma can decrease clinical anastomotic leak rate and reoperation rate,thus it is recommended to apply in low anterior resection for rectal cancer.