直肠癌腹会阴联合切除术后会阴伤口并发症危险因素的Meta分析  

A meta-analysis on risk factors of postoperative perineal wound complications after abdominoperineal resection for rectal cancer

作　　者：陆森琪 常小峰[2] 杨小冬 俞德才 黄其根 王锋[1] Lu Senqi Chang Xiaofeng Yang Xiaodong Yu Decai Huang Qigen Wang Feng(Department of General Surgery, Jiaugsu Province Hospital, Nanjing 2]0029, China （Lu SQ, Yang XD, Wang F Southeast University School of Medicine, Nanjing 210009, China （Chang XF Department of General Surgery, Qixia District Hospital, Nanjing 210033, China （ Yu DC, Huang QG ） Lu Senqi and Chang Xiaofeng are the first authors who contributed equally to the article)

机构地区：[1]南京医科大学普通外科,211166 [2]东南大学医学院,南京210009 [3]南京市栖霞区医院普通外科,210033

出　　处：《中华胃肠外科杂志》2017年第10期1180-1187,共8页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的采用Meta分析的方法探究直肠癌腹会阴联合切除术后会阴伤口并发症发生的危险因素。方法检索Medline、Embase、Webof Science、Ovid、Cochrane Library、中国生物医学文献数据库、中国期刊全文数据库、维普中文期刊数据库、万方数据库等关于直肠癌腹会阴联合切除术的临床研究，检索时间为建库至2016年10月。分别采用“Cochrane风险偏倚评估工具”和“纽卡斯尔．渥太华量表”进行文献质量评价。使用Cochrane协作网提供的Review Manager4．3软件进行Meta分析。结果共纳入8个随机对照研究和33个非随机对照研究，15287例患者。Meta分析结果显示：新辅助放疗（OR=2．55，95％CI：1．66～3．93，P〈0．01）、肥胖（OR：2．12，95％CI：1．05—4．26，P=0．04）会增加直肠癌腹会阴联合切除术后会阴伤口并发症的发生率，网膜成形术（OR=0．30，95％CI：0．14～0．67，P=0．003）、骶前冲洗（OR=0．11，95％CI：0．01～0．94。P=0．04）、经腹部引流（OR=0．36，95％CI：0．21—0．63，P〈0.01）、经会阴皮肤引流（OR=41．72，95％CI：2．39～727．90，P=O．01）以及局部应用抗生素（OR=0．17，95％CI：0．07～0．40，P〈0．01）会降低会阴伤口并发症的发生率，而肛提肌外腹会阴联合切除术（OR=0．88，95％CI：0．57—1．35，P=0．56）、腹腔镜技术（OR：1．02，95％CI：0．47—2．21，P=0．96）、生物补片（OR=1．81，95％CI：0．95～3．46，P=0．07）和肌皮瓣（OR=1．32，95％CI：0．18～9．91，P=0．79）盆底修复技术以及负压引流（OR=0．69，95％CI：0．35。1．34，P=0．27）并不影响会阴伤口的愈合。结论多种因素会影响直肠癌腹会阴联合切除术后会阴伤口并发症的发生，仍需要开展多中心、大样本、高质量随机对照研究加以验证。Objective To investigate the risk factors of postoperative perineal wound comphcations after abdominoperineal resection for rectal cancer. Methods The databases of Medhne, Embase, Web of Science, Ovid, Cochrane Library, CBM, CNKI, VIP and WANFANG were searched for the studies of abdominoperineal resection up to October 2016. The quality of the included studies was assessed by using ＂Cochrane collaboration＇s tool for assessing risk of bias＂ and ＂the Newcastle- Ottawa Scale＂. The meta-analyses were performed with Review Manager 4.3 software. Results Eight randomized controlled trials and 33 non-randomized controlled trials with 15 287 patients were enrolled. Meta-analyses showed that neoadjuvant radiotherapy （OR = 2.55, 95%CI： 1.66 to 3.93, P 〈 0.01） and obesity （OR = 2.12, 95%CI： 1.05 to 4.26, P = 0.04） significant].y increased the morbidity of perineal wound complication after abdominoperineal resection for rectal cancer; omentoplasty （OR = 0.30, 95%CI： 0.14 to 0.67, P = 0.003）, presacral space clysis （OR = 0.11, 95%CI： 0.01 to 0.94, P = 0.04）, abdominal drainage （0R=0.36, 95%CI： 0.21 to 0.63, P 〈 0.01）, perineal skin drainage（OR = 41.72, 95%CI： 2.39 to 727.90, P= 0.01） and local application of antibiotics （OR =0.17,95%CI： 0.07 to 0.40, P 〈 0.01） significantly decreased the morbidity of perineal wound complication; however, extralevator abdominoperineal excision （0R=0.88, 95%CI： 0.57 to 1.35, P= 0.56）, laparoscopic procedure （OR= 1.02, 95%CI： 0.47 to 2.21, P = 0.96）, biologic mesh reconstruction （OR = 1.81, 95%CI： 0.95 to 3.46, P = 0.07）, myocutaneous flap reconstruction （OR= 1.32, 95%CI： 0.18 to 9.91, P = 0.79） and negative pressure drainage （OR = 0.69, 95%CI： 0.35 to 1.34, P = 0.27） had no influence on the healing of perineal wound. Coneltmions Numerous factors can affect the occurrence of perineal wound complication after abdominoperineal resection for rectal cancer. Due to the limitations of enrolled studies, muhicenter la

关 键 词：腹会阴联合切除术 直肠肿瘤 并发症 META分析 

分 类 号：R735.37[医药卫生—肿瘤]