结直肠癌患者手术切口感染危险因素的Meta分析

Risk Factors for Surgical Incision Infection in Patients with Colorectal Cancer: A Meta-analysis

目的通过Meta分析探讨结直肠癌患者手术切口感染的危险因素,为制定预防措施提供参考依据。方法计算机检索中国知网、中国生物医学文献数据库、万方数据库、维普数据库、The Cochrane Library、PubMed、Embase、Web of Science数据库,收集关于结直肠癌手术切口感染危险因素的病例对照研究和队列研究。由2名研究者根据纳入与排除标准进行文献筛选,并运用纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale,NOS)对纳入文献进行质量评价。结果最终纳入17篇文献,累计结肠癌患者16 992例。Meta分析结果显示糖尿病(OR=1.65,95%CI:1.48~1.84)、手术时间≥3 h(OR=1.41,95%CI:1.22~1.63)、体质量指数(Body Mass Index, BMI)≧30 kg/m^(2)(OR=1.35,95%CI:1.18~1.55)、开腹手术(OR=1.60,95%CI:1.23~2.07)、手术方式(OR=1.69,95%CI:1.38~2.08)、肿瘤分期(OR=1.42,95%CI:1.28~1.58)、年龄(OR=1.28,95%CI:1.12~1.47)为结直肠癌患者手术切口感染的危险因素。敏感性分析与发表偏倚结果显示各因素合并结果比较稳定,发表偏倚不明显。结论对结直肠癌患者基础疾病、手术时间、体质量、手术方式、肿瘤分期及年龄等进行管理可有效降低手术切口感染的发生率。

Objective To clarify the risk factors of surgical incision infection in patients with colorectal cancer through meta-analysis,and to provide reference for preventive measures.Methods Case-control studies and cohort studies on risk factors of surgical incision infection in patients with colorectal cancer were searched in databases including CNKI,China Biomedical Literature Database,Wanfang Database,Weipu Database,The Cochrane Library,PubMed,Embase,and Web of Science.Two researchers screened the literature according to the inclusion and exclusion criteria,and evaluated the quality of the included literature by Newcastle-Ottawa Scale(NOS).RevMan5.3 was used to perform statistical analysis.Results Seventeen articles were finally included,with a total of 16,992 cases of colon cancer,and 8 risk factors.Meta-analysis showed that diabetes(OR=1.65,95%CI:1.48~1.84),operation time(OR=1.41,95%CI:1.22~1.63),BMI(OR=1.35,95%CI:1.18~1.55),open surgery(OR=1.60,95%CI:1.23~2.07),surgical method(OR=1.69,95%CI:1.38~2.08),tumor stage(OR=1.42,95%CI:1.28~1.58),and age(OR=1.28,95%CI:1.12~1.47)were risk factors for surgical incision infection in patients with colorectal cancer.Sensitivity analysis and publication bias results show that the combined results of all factors were relatively stable,and no obvious publication bias was found.Conclusion Effective management for basic disease,operation time,weight,open surgery,operation method,tumor stage and age can effectively reduce the incidence of surgical incision infection.