结肠支架置入术后择期手术与急诊手术治疗梗阻性结肠癌疗效及预后的Meta分析

Meta-analysis of the efficacy and prognosis of elective surgery and emergency surgery after colonic stenting for obstructive colon cancer

目的系统评价结肠支架置入术后择期手术与急诊手术治疗结肠癌合并梗阻的疗效及预后。方法检索中国知网、万方、维普、中国生物医学文献数据库(CBM)、PubMed、Cochrane图书馆、EmBase数据库中关于结肠支架置入术后择期手术与急诊手术治疗梗阻性结肠癌的随机对照试验,对纳入文献进行质量评价,提取相关结局指标使用Revman 5.3软件进行数据分析。最后通过绘制漏斗图判断有无发表偏倚。结果共纳入12篇随机对照试验研究进行Meta分析,对比结肠支架置术入后择期手术与急诊手术在一期手术吻合率(P=0.004)、永久造口率(P=0.0002)、并发症发生率(P=0.0007)差异有统计学意义,在围术期死亡率、复发率、3年总体生存率及3年无病生存期差异无统计学意义(P>0.05)。结论结肠支架作为手术过渡可以提高一期手术吻合率、降低永久造口率及并发症发生率,在长期预后方面与急诊手术无显著差异。

Objective To systematically evaluate the efficacy and prognosis of elective surgery and emergency surgery after colonic stenting in the treatment of colon cancer complicated with obstruction.Methods Randomized controlled trials on elective surgery and emergency surgery after colonic stenting for obstructive colon cancer were retrieved from CNKI,WanFang,VIP,CBM,PubMed,Cochrane Library and EmBase databases,and the quality of the included literatures was evaluated.The relevant outcome indicators were extracted and analyzed by Revman 5.3 software.Finally,the funnel plot was drawn to determine whether there was publication bias.Results A total of 12 studies were included for Meta-analysis.There were statistically significant differences in the anastomosis rate(P=0.004),permanent stoma rate(P=0.0002)and complication rate(P=0.0007)between elective surgery and emergency surgery after colonic stenting.There were no significant differences in perioperative mortality,recurrence rate,3-year overall survival(OS)and 3-year disease-free survival(DFS).Conclusion Colonic stenting as a transition can improve the anastomosis rate,reduce the rate of permanent stoma and complications,and there is no significant difference in long-term prognosis compared with emergency surgery.