内镜支架减压对比肠造口减压对梗阻性结直肠癌择期手术近远期疗效影响的Meta分析

Endoscopic stent decompression versus stoma decompression on short-and long-term efficacy as a bridge to elective resection for obstructive colorectal cancer:A meta-analysis

目的比较急诊造口减压和内镜支架减压后择期手术切除治疗梗阻性结直肠癌的近远期效果。方法检索PubMed、Embase、Cochrane Library、中国知网、万方数据库已公开发表的有关造口减压对比内镜支架减压后序贯择期手术切除的梗阻性结直肠癌近远期效果的文献,提取的数据采用RevMan 5.3软件进行Meta分析。结果共10篇回顾性病例对照研究纳入汇总分析,Newcastle-Ottawa Scale评分范围为6~8分,其中高质量文献6篇。总样本量为1807例,包括造口组939例,支架组868例。汇总分析结果提示,支架组两次手术间隔时间短于造口组(WMD=13.37,95%CI:7.88~18.86,P<0.00001),但造口组择期手术一期吻合率高于支架组(OR=1.58,95%CI:1.10~2.26,P=0.01),3年总生存率也高于支架组(HR=0.77,95%CI:0.61~0.97,P=0.02)。两组在择期手术入路方式、永久性造口率、总体并发症和围手术期死亡率方面比较,差异均无统计学意义。结论肠造口减压和内镜支架减压对梗阻性结直肠癌患者后续择期行结直肠癌根治术的安全性相近,但是肠造口减压患者的总生存率更高,远期疗效方面更胜一筹。

Objective To compare the short-and long-term efficacy after endoscopic stent versus stoma decompression as a bridge to elective resection for obstructive colorectal cancer.Methods The databases such as Pub Med,Embase,Cochrane Library,CNKI,Wan Fang data were searched to retrieve literature comparing stoma decompression with endoscopic stent as a bridge to surgery for obstructive colorectal cancer.Data were extracted and analyzed using Rev Man 5.3 statistical software.Results Ten retrospective case-control studies were finally retrieved,with 6-8 points by the Newcastle-Ottawa Scale,6 of which were high-quality literatures.A total of 1807 cases were included in the study,939 of whom were divided into stoma group and 868 were stent group.Compared to the stoma group,the stent group was associated with significantly shorter time interval between decompression surgery and elective resection for obstructive colorectal cancer(WMD=13.37,95%CI:7.88-18.86,P<0.00001).However,the stoma group showed better primary anastomotsis(OR=1.58,95%CI:1.10-2.26,P=0.01)and 3-year overall survival than the stent group(HR=0.77,95%CI:0.61-0.97,P=0.02).No significant differences were found in terms of surgical approach,permanent stoma,overall complication and perioperative mortality between the two groups.Conclusions The stoma decompression as a bridge to surgery provides similar safety with endoscopic stent for patients with obstructive colorectal cancer undergoing subsequent elective radical resection.However,stoma decompression has advantages of long-term efficacy,providing higher overall survival.