结肠支架置入联合择期手术与急诊手术治疗梗阻性左半结肠癌远期预后的Meta分析

Long-term oncologic outcomes of stent as a bridge to surgery versus emergency surgery in malignant left side colonic obstructions:A Meta-analysis

目的:对比结肠支架置入联合择期手术和急诊手术对于梗阻性左半结肠癌的长期预后。方法:检索国内外相关数据库正式发表的关于支架植入联合择期手术与急诊手术对于梗阻性左半结肠癌的临床研究文献,检索时间截止至2018年8月。对纳入文献进行质量评价并提取所需结局指标后用RevMan 5.3软件进行数据分析。结果:共纳入10篇文献,共计804名患者(其中支架组388例,急诊手术组416例),Meta分析结果显示支架组与急诊手术组长期预后无统计学差异。局部复发率(RR=1.26;95%CI:0.76~2.07,P=0.37)和总复发率(RR=1.45;95%CI:0.93~2.27,P=0.10)无明显统计学差异;总生存时间(HR=0.98;95%CI:0.67~1.44,P=0.92)与无病生存时间(HR=1.02;95%CI:0.71~1.46,P=0.90)也无明显统计学差异。结论:结肠支架置入联合择期手术和急诊手术有相似的肿瘤长期性结果,在具有支架植入经验丰富的中心进行治疗是治疗梗阻性左半结肠癌的最佳选择。

Objective:To contrast colonic stent placement combined with emergency surgery for long-term prognosis of obstructive left colon cancer.Methods:The clinical literature published in the relevant database at home and abroad on stent implantation combined with elective surgery and emergency surgery for obstructive left colon cancer was searched.The search time was until August 2018.The quality of the included literature was evaluated and the required outcome indicators were extracted.Data were analyzed using RevMan 5.3 software.Results:A total of 10 articles were included in the study.A total of 804 patients included stent group 388,emergency surgery group 416.Meta-analysis showed no significant difference in long-term prognosis between the stent group and the emergency surgery group.Local recurrence rate(RR=1.26;95%CI:0.76~2.07,P=0.37)and total recurrence rate(RR=1.45;95%CI:0.93~2.27,P=0.10)had no significant difference.Overall survival time(HR=0.98;95%CI:0.67~1.44,P=0.92)and disease-free survival time(HR=1.02;95%CI:0.71~1.46,P=0.90)had no statistically significant difference.Conclusion:Colon stent implantation combined with emergency surgery has similarities.The long-term outcome of the tumor,in an experienced center with stent implantation,is the best choice for the treatment of obstructive left colon cancer.