经内镜结肠支架置入后再行手术与急诊手术治疗梗阻性左半结肠癌的Meta分析  

Endoscopic colonic stents and planned surgery versus emergency surgery for obstructive left colon cancer:a Meta-analysis

作　　者：祝保玺 徐艺可[1] 阿不都外力.吾守尔 王云海[1] 

机构地区：[1]新疆医科大学第一附属医院胃肠外科,新疆乌鲁木齐830054

出　　处：《中国普通外科杂志》2014年第4期436-441,共6页China Journal of General Surgery

摘　　要：目的：探讨经内镜结肠支架置人后再行手术治疗梗阻性左半结肠癌的价值与风险。方法：检索国内外多个数据库，收集相关的随机对照试验。根据纳入和排除标准筛选文献、提取资料和进行质量评价，采用RevMan5．2进行Meta分析。结果：最终纳入6个随机对照试验，共322例患者，其中经内镜结肠支架置人后再行手术治疗165例（支架组），行急诊手术157例（急诊手术组）。Meta分析显示，与急诊手术组比较，支架组造瘘率和切口感染率降低（OR=0．41，95％CI=0．24—0．69，P=0．0009；OR=0．34，95％CI=0．13~0．86，P=0．02），一期手术吻合率增加（OR=2．84，95％CI=1．68～4．80，P〈0．0001），但病死率、吻合口瘘、总并发症、非计划再手术、腹腔感染的差异无统计学意义（均P〉0．05）。结论：经内镜支架置入后再行手术，可降低造瘘率和切口感染发生率，增加一期手术吻合率，但并发症发生率和病死率方面无明显优势。Objective： To investigate the value and risk of endoscopic colonic stents and planned surgery for obstructive left- sided colon cancer, Methods： The relevant randomized controlled trials （RCTs） were collected by searching several national and international online databases. After screening for inclusion, data extraction, and quality assessment, Meta- analysis was performed by the RevMan 5.2 software. Results： Six RCTs were finally included involving 322 patients, of whom 165 cases underwent endoscopic colonic stents and planned surgery （stenting group）, and 157 cases received emergency surgery （emergency surgery group）. Results of the Meta-analysis showed that, in stenting group versus emergency surgery group, thefistulization rate and incidence of wound infections were significantly decreased （OR=0.41, 95% CI=0.24-0.69, P=0.0009; 0R=0.34, 95% CI=0.13-0.86, P=0.02）, and the primary anastomosis rate was significantly increased （OR=2.84, 95% CI=1.68-4.80, P〈0.0001）, while the differences in mortality, and incidence of anastomotic leakage, overall complications, unplanned reoperations, and abdominal infection （P=0.58） had no statistical significance （all P〉0.05）. Conclusion： Endoscopic colonic stents and planned surgery can reduce the fistulization rate and incidence of wound infections, and increase the primary anastomosis rate, but has no beneficial effect in improvement of theoverall rates of complications and mortaliW.

关 键 词：结肠肿瘤 肠梗阻 支架 META分析 

分 类 号：R735.3[医药卫生—肿瘤]