完全经肛门拖出术和腹腔镜辅助拖出术治疗先天性巨结肠疗效比较的meta分析  

Totally transanal endorectal pull-through versus laparoscopic assistance endorectal pull-through in treatment of Hirschsprung’s disease:a meta-analysis

作　　者：王樾 黄冉[1] 吴文涌[2] 李涛[1] 李巍松[1] WANG Yue;HUANG Ran;WU Wenyong;LI Tao;LI Weisong(Department of Pediatric Surgery,The First Affiliated Hospital of Anhui Medical University,Hefei 230032,P.R.China;Department of Gastrointestinal Surgery,The First Affiliated Hospital of Anhui Medical University,Hefei 230032,P.R.China)

机构地区：[1]安徽医科大学第一附属医院小儿外科,合肥230032 [2]安徽医科大学第一附属医院胃肠外科,合肥230032

出　　处：《中国普外基础与临床杂志》2021年第4期430-437,共8页Chinese Journal of Bases and Clinics In General Surgery

基　　金：国家自然科学基金面上项目(项目编号:81572305)。

摘　　要：目的比较完全经肛门拖出术和腹腔镜辅助拖出术治疗先天性巨结肠(HD)的疗效。方法检索PubMed、EMBASE、The Cochrane Library、中国知网、万方数据库和维普信息资源系统,筛选出1998年1月至2020年5月期间发表的有关完全经肛门拖出术与腹腔镜辅助拖出术治疗HD的对比研究。由两名评价员独立完成文献筛选、数据提取及质量评价后,应用Review Manager 5.3软件对纳入文献的术后效果指标进行效应量合并。采用Stata 14.0软件对纳入文献的发表偏倚进行Begg’s及Egger’s检验。结果最终共纳入8篇符合标准的临床研究,HD患儿共计702例,其中完全经肛门拖出术组335例,腹腔镜辅助拖出术组367例。与腹腔镜辅助拖出术组相比,完全经肛门拖出术组在术后大便失禁/污粪发生率方面有优势[OR=0.20,95%CI(0.07,0.54),P=0.001],而术后便秘复发率却较高[OR=2.39,95%CI(1.05,5.42),P=0.04]。但2组的术后小肠结肠炎[OR=1.01,95%CI(0.59,1.75),P=0.96]、术后粘连性肠梗阻[OR=0.74,95%CI(0.28,1.95),P=0.54]和术后吻合口狭窄[OR=1.14,95%CI(0.51,2.56),P=0.74]发生率比较差异均无统计学意义。结论与腹腔镜辅助拖出术相比,完全经肛门拖出术可降低术后大便失禁/污粪发生率,但术后便秘复发率较高。2种术式治疗HD具有相似的术后小肠结肠炎、吻合口狭窄及粘连性肠梗阻发生率。Objective To compare the efficacy of totally transanal endorectal pull-through and laparoscopic assistance endorectal pull-through in the treatment of Hirschsprung’s disease(HD).Methods PubMed,EMBASE,The Cochrane Library,CNKI,Wanfang,and VIP Database were searched to screen out the comparative studies published between January 1998 and May 2020 on the treatment of HD with totally transanal endorectal pull-through and laparoscopic assistance endorectal pull-through.Then two reviewers independently completed the literatures screening,data extraction,and quality evaluation.The Review Manager 5.3 software was used to combine the effect size of the postoperative effect indicators included in the literatures.Stata 14.0 software was used to perform Begg’s and Egger’s tests on the publication bias of the included literatures.Results A total of 8 clinical studies conforming to the standards were included and 702 cases of children undergoing HD radical resection were recorded,including 335 cases in the totally transanal endorectal pull-through group and 367 cases in the laparoscopic assistance endorectal pull-through group.Compared with the laparoscopic assistance endorectal pull-through group,the totally transanal endorectal pullthrough group had an advantage in the incidence of postoperative faecal incontinence/soiling[OR=0.20,95%CI was(0.07,0.54),P=0.001],and the postoperative constipation recurrence rate was higher than the laparoscopic assistance endorectal pull-through group[OR=2.39,95%CI was(1.05,5.42),P=0.04].There were no statistically significant differences between the two groups in terms of postoperative enterocolitis[OR=1.01,95%CI was(0.59,1.75),P=0.96],postoperative adhesion intestinal obstruction[OR=0.74,95%CI was(0.28,1.95),P=0.54],and postoperative anastomotic stenosis[OR=1.14,95%CI was(0.51,2.56),P=0.74].Conclusions Compared with laparoscopic assistance endorectal pull-through,the totally transanal endorectal pull-through can reduce the incidence of postoperative faecal incontinence/soiling,but the

关 键 词：先天性巨结肠 儿童 经肛门拖出术 腹腔镜 META分析 

分 类 号：R726.5[医药卫生—儿科]