腹腔镜右半结肠切除术中腔内吻合对比腔外吻合对术后并发症的影响的Meta分析  

Comparison of postoperative complications between intracorporeal and extracorpo⁃real anastomosis in laparoscopic right-sided hemicolectomy:a Meta-analysis

作　　者：赵威[1] 董元航 梅祖兵[3] Zhao Wei;Dong Yuanhang;Mei Zubing(Department of General Surgery,Putuo District Central Hospital of Shanghai,Shanghai 200062,China;Department of Gastroenterology,The First Affiliated Hospital of Naval Medical University,Shanghai 200433,China;Department of Anorectal Surgery/Research Institute of Anorectal Diseases,Shuguang Hospital—Affiliated Hospital of the Shang-hai University of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]上海市普陀区中心医院普外科,上海200062 [2]海军军医大学第一附属医院消化科,上海200433 [3]上海中医药大学附属曙光医院肛肠科/肛肠病研究所,上海201203

出　　处：《结直肠肛门外科》2022年第5期482-487,共6页Journal of Colorectal & Anal Surgery

摘　　要：目的系统评价腹腔镜右半结肠切除术中腔内吻合对比腔外吻合对术后并发症的影响。方法检索PubMed、Embase、The Cochrane Library和中国生物医学文献服务系统(SinoMed)等数据库1980年1月至2022年6月发表的有关腹腔镜右半结肠切除术中腔内吻合对比腔外吻合对术后并发症的影响的随机对照研究(RCT)进行Meta分析。两名研究员共同筛选文献、提取数据和进行偏倚评价,应用Stata 12.0软件对数据进行Meta分析。结果最终纳入6项RCT,共计661例患者进行Meta分析,结果表明与腔外吻合组相比,腹腔镜右半结肠切除术中腔内吻合组的手术切口感染发生率更低【RR=0.50,95%CI(0.26~0.97),P=0.04】;两组其余并发症包括吻合口漏【RR=0.93,95%CI(0.48~1.79),P=0.83】、术后肠梗阻【RR=0.66,95%CI(0.30~1.42),P=0.28】、术后出血【RR=1.96,95%CI(0.15~25.8),P=0.61】、再手术【RR=0.60,95%CI(0.32~1.14),P=0.12】、30天内再入院【RR=0.48,95%CI(0.21~1.07),P=0.07】和术后死亡【RR=0.74,95%CI(0.26~2.11),P=0.57】的发生率比较差异均无统计学意义。结论与腔外吻合相比,腹腔镜右半结肠切除术中腔内吻合可降低手术切口感染发生率,而对其余术后并发症未见有影响,有待更多大样本、多中心的临床研究进一步验证。Objectives To systematically compare postoperative complications between intracorporeal and extracorporeal anastomo⁃sis in laparoscopic right-sided hemicolectomy.Methods A literature search was conducted using PubMed,Embase,the Co⁃chrane Library,and the SinoMed database.Eligible studies for the Meta-analysis were randomized controlled trials(RCTs)compar⁃ing postoperative complications between intracorporeal and extracorporeal anastomosis in laparoscopic right-sided hemicolectomy published between January 1980 and June 2022.Two independent reviewers conducted screening,selection,data extraction,and risk of bias assessment.Meta-analysis was performed using Stata 12.0.Results Six RCTs with a total of 661 patients were in⁃cluded.Compared with extracorporeal anastomosis,intracorporeal anastomosis in laparoscopic right-sided hemicolectomy had a low⁃er rate of wound infection[relative risk(RR)=0.50,95%confidence interval(CI):0.26-0.97,P=0.04].Rates of other complica⁃tions did not differ significantly between the two groups:anastomotic leakage(RR=0.93,95%CI:0.48-1.79,P=0.83),postoperative intestinal obstruction(RR=0.66,95%CI:0.30-1.42,P=0.28),postoperative bleeding(RR=1.96,95%CI:0.15-25.8,P=0.61),reopera⁃tion(RR=0.60,95%CI:0.32-1.14,P=0.12),readmission within 30 days of discharge(RR=0.48,95%CI:0.21-1.07,P=0.07),and death(RR=0.74,95%CI:0.26-2.11,P=0.57).Conclusion Compared with extracorporeal anastomosis,intracorporeal anastomosis in laparoscopic right-sided hemicolectomy can lower the incidence of wound infection but has no significant effect on lowering the risks of other complications.These results warrant multicenter clinical trials with large samples to confirm.

关 键 词：结肠肿瘤 腹腔镜右半结肠切除术 腔内吻合 腔外吻合 术后并发症 META分析 

分 类 号：R735.35[医药卫生—肿瘤]