金属支架联合腹腔镜与急诊开腹手术治疗结直肠癌急性肠梗阻近期疗效的meta分析  

The short-term curative effect of self-expanding metal stents combined with laparoscopy and emergency laparotomy for acute intestinal obstruction of colorectal cancer: a meta-analysis

作　　者：侯松林 刘带志[1,2] 蒋先虹 张帆 陈小波 李利发[2] 张广军 周彤[1,2] HOU Song-lin;LIU Dai-zhi;JIANG Xian-hong(Department of Gastrointestinal Surgery,Institute of Hepato-Biliary-Pancreas and Intestinal Disease,North Sichuan Medical College,Nanchong 637000,China;Affiliated Hospital of North Sichuan Medical College)

机构地区：[1]川北医学院肝胆胰肠研究所,四川南充637000 [2]川北医学院附属医院

出　　处：《腹腔镜外科杂志》2018年第11期844-853,共10页Journal of Laparoscopic Surgery

摘　　要：目的:比较金属支架联合腹腔镜与急诊开腹手术治疗结直肠癌所致急性肠梗阻的近期疗效。方法:检索2007～2017年中国知网、万方数据库、维普科技期刊、中国生物医学数据库、PubMed、Cochrane、Embase等中英文数据库有关金属支架联合腹腔镜与急诊开腹手术治疗结直肠癌急性肠梗阻的文献,并严格按照纳入排除标准筛选合格文献,利用Rev Man 5.3软件进行统计学处理。结果:共纳入文献14篇,包含患者933例,Meta分析结果显示与开腹组相比,金属支架联合腹腔镜组切除淋巴结数量多[WMD=3.05,95%CI(0.99,5.11),P<0.01]、手术时间短[WMD=-43.58,95%CI(-61.22,-25.94),P<0.01]、术中出血少[WMD=-94.42,95%CI(-166.86,-21.98),P=0.01]、肠道排气时间短[WMD=-1.40,95%CI(-1.95,-0.84),P<0.01]、住院时间短[WMD=-3.74,95%CI(-4.25,-3.24),P<0.01]、术后总并发症少[OR=0.15,95%CI(0.08,0.27),P<0.01]、吻合口漏少[OR=0.25,95%CI(0.10,0.62),P<0.01]、腹腔感染少[OR=0.21,95%CI(0.05,0.80),P=0.02]、切口感染少[OR=0.14,95%CI(0.07,0.29),P<0.01],但局部复发率[OR=1.49,95%CI(0.53,4.20),P=0.45]、炎性肠梗阻发生率[OR=0.26,95%CI(0.07,1.00),P=0.05]两组差异无统计学意义。结论:与急诊开腹手术相比,金属支架联合腹腔镜治疗结直肠癌急性肠梗阻近期疗效更具安全性、有效性与可靠性。Objective:To compare the short-term efficacy of self-expanding metal stents combined with laparoscopy and emergency laparotomy for acute intestinal obstruction of colorectal cancer.Methods:Relevant literature was retrieved from databases including CNKI,Wanfang database,VIP,CBM,PubMed,Cochrane Library databases and Embase databases from 2007 to 2017,all the relevant trials were collected for comparison of self-expanding metal stents combined with laparoscopy and emergency laparotomy on the clinical efficacy for acute intestinal obstruction of colorectal cancer,the qualified literature was screened in strict accordance with inclusion and exclusion criteria,and RevMan 5.3 software was used for statistical analysis.Results:A total of 14 articles with 933 patients were included.Meta-analysis showed self-expanding metal stents combined with laparoscopy group vs.emergency laparotomy group:intraoperative lymph node resection was increased[WMD=3.05,95%CI(0.99,5.11),P<0.01],operation time was reduced[WMD=-43.58,95%CI(-61.22,-25.94),P<0.01],intraoperative blood loss was reduced[WMD=-94.42,95%CI(-166.86,-21.98),P=0.01],postoperative exhaust time was reduced[WMD=-1.40,95%CI(-1.95,-0.84),P<0.01],postoperative hospitalization time was reduced[WMD=-3.74,95%CI(-4.25,-3.24),P<0.01],postoperative overall complication was reduced[OR=0.15,95%CI(0.08,0.27),P<0.01],anastomotic fistula was reduced[OR=0.25,95%CI(0.10,0.62),P<0.01],abdominal infection was reduced[OR=0.21,95%CI(0.05,0.80),P=0.02],infection of incision was reduced[OR=0.14,95%CI(0.07,0.29),P<0.01].The differences were not significant in local recurrence[OR=1.49,95%CI(0.53,4.20),P=0.45]or inflammatory intestinal obstruction[OR=0.26,95%CI(0.07,1.00),P=0.05].Conclusions:Self-expanding metal stents combined with laparoscopy has safer,more effective and reliable effect than emergency laparotomy for acute intestinal obstruction of colorectal cancer.

关 键 词：结直肠肿瘤 肠梗阻 金属支架 腹腔镜检查 剖腹术 META分析 

分 类 号：R735.34[医药卫生—肿瘤]