肠系膜下动脉高低位结扎对直肠癌和乙状结肠癌术后影响的Meta分析  

Postoperative complications of IMA high and low ligation in rectal cancer and sigmoid colon cancer:a meta-analysis

作　　者：何杰 张帮柱 周军 邓涛 蔺原 HE Jie;ZHANG Bang-zhu;ZHOU Jun;DENG Tao;LIN Yuan(Department of General Surgery,The Affiliated Hospital of Panzhihua College,Panzhihua 61700,China)

机构地区：[1]四川省攀枝花学院附属医院普外科,四川攀枝花617000

出　　处：《中国现代普通外科进展》2023年第6期443-447,共5页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:探讨高位和低位结扎肠系膜下动脉对直肠癌和乙状结肠癌术后的影响。方法:通过使用数据库PubMed、EMBASE、Cochrane Library、Web of science、CNKI、WANFANG、CBM搜索从建库至2021年4月1日的相关文献。使用Cochrane统计学软件Review Manager5.3版进行Meta分析。结果:检索出总文献1251篇,中文634篇,英文617篇。筛选出符合要求文献21篇,英文9篇,中文12篇。总病例数3372例,高位结扎1493例,低位结扎1879例。Meta分析结果显示:低位结扎的吻合口瘘(RR:1.37,95%CI:1.16~1.62,P<0.05)和泌尿系功能障碍(OR:2.38,95%CI:1.29~4.41,P<0.05)发生率更低、胃肠功能恢复(MD:0.32,95%CI:0.10~0.54,P<0.05)更快;术后肠梗阻、吻合口狭窄、非计划手术、5年生存率和5年无病生存率差异无统计学意义(P>0.05)。结论:肠系膜下动脉高位结扎并不能显著改善术后直肠癌和乙状结肠癌患者的生存率,反而会增加术后并发症。Objective:To explore the difference between postoperative complications of high and low ligation of inferior mesenteric artery.Methods:The databases of PubMed,EMBASE,Cochrane Library,Web of science,CNKI,WANFANG and CBM were retrieved to find relevant from database establishment to April 1,2021 The meta-analysis was performed by using Cochrane statistical software Review Manager5.3.Results:The total of 1251 articles that 634 were Chinese and 617 were English were retrieved.The 21articles that 12 were Chinese and 9 were English were screened.The total number of cases was 3372.The high ligation was1493 and low ligation was 1879 The meta-analysis of postoperative complications showed,compared with high ligation of the inferior mesenteric artery,low-position ligation of the inferior mesenteric artery has a lower incidence of anastomotic leakage(RR:1.37,95%CI:1.16~1.62,P<0.05),less urinary dysfunction(OR:2.38,95%CI:1.29~4.41,P<0.05),and faster recovery of gastrointestinal function after surgery(MD:0.32,95%CI:0.10~0.54,P<0.05).The meta-analysis result of postoperative intestinal obstruction,anastomotic stenosis,unplanned surgery,5-year survival rate and 5-year disease-free survival rate were not statistically significantz(P>0.05).Conclusion:The high ligation of IMA does not significantly improve the survival rate of patients with sigmoid colon and rectal cancer after surgery.However,it increases postoperative complications.

关 键 词：结肠肿瘤 直肠肿瘤 肠系膜下动脉 高位结扎 低位结扎 META分析 

分 类 号：R735.35[医药卫生—肿瘤] R735.37[医药卫生—临床医学]