肠道支架置入术后择期手术和急诊手术治疗结直肠癌急性肠梗阻疗效的meta分析

Efficacy and safety of selective surgery after colonic stenting versus emergency surgery for acute obstructive colorectal cancer: a meta-analysis

目的比较肠道支架置入术后择期行手术和急诊手术治疗结直肠癌致肠梗阻患者的疗效和安全性。方法检索Pubmed、Embase、Cochrane Library、中国知网、万方和维普文献数据库,收集2000年1月1日至2018年7月31日期间公开发表的文献,并用Cochrane协作网提供的RevMan5.3软件进行meta分析。结果共计21篇文献纳入本次meta分析,先置入肠道支架后择期行手术和急诊手术相比,死亡率[OR=0.44,95%CI为(0.26,0.73),P<0.05]、永久造口率[OR=0.46,95%CI为(0.23,0.94),P<0.05]、并发症发生率[OR=0.47,95%CI为(0.35,0.63),P<0.05]和切口感染发生率[OR=0.40,95%CI为(0.25,0.65),P<0.05]均较低,一期吻合率[OR=3.30,95%CI为(2.47,4.41),P<0.05]和腹腔镜手术率[OR=12.55,95%CI为(3.64,43.25),P<0.05]较高,但两者的吻合口漏发生率[OR=0.86,95%CI为(0.48,1.55),P>0.05]比较差异无统计学意义。结论置入肠道支架后择期行手术较急诊手术,其死亡率、并发症发生率、永久造口率和切口感染发生率低,一期吻合率和腹腔镜手术率高。对于结直肠癌急性肠梗阻,肠道支架置入术后择期手术优于急诊手术治疗。

Objective The aim of this current meta-analysis is to evaluate the efficacy and safety of selective surgery after colonic stenting versus emergency surgery for acute obstructive colorectal cancer.Methods The studies published from January 1,2000 to July 31,2018 were searched from Pubmed,Embase,Cochrane Library,CNKI,Wanfang database,and VIP database.RevMan 5.3 software was used for data analysis.Results A total of 21 studies were included in this meta-analysis.Compared to emergency surgery,selective surgery after colonic stenting had significant lower mortality rate[OR=0.44,95%CI was(0.26,0.73),P<0.05],permanent stoma rate[OR=0.46,95%CI was(0.23,0.94),P<0.05],complication rate[OR=0.47,95%CI was(0.35,0.63),P<0.05],and wound infection rate[OR=0.40,95%CI was(0.25,0.65),P<0.05],but had significant higher primary anastomosis rate[OR=3.30,95%CI was(2.47,4.41),P<0.05]and laparoscopic surgery rate[OR=12.55,95%CI was(3.64,43.25),P<0.05].But there was no significant differences between the two groups as to anastomotic leak rate[OR=0.86,95%CI was(0.48,1.55),P>0.05].Conclusions Selective surgery after colonic stenting can be identified in a reduced incidence of mortality rate,complication rate,permanent stoma rate,and wound infection rate,and also can increase primary anastomosis rate and laparoscopic surgery rate.Thus,for acute obstructive colorectal cancer,selective surgery after colonic stenting is better than emergency surgery.