低位直肠癌保肛手术延迟结肛吻合与一期吻合疗效对比的Meta分析  

Delayed Coloanal Anastomosis Versus Immediate Coloanal Anastomosis for Low Rectal Cancer:A Meta-Analysis

作　　者：贾蓉 李权林 张肖 范雨诗 李敏 杨邦翠 任明扬 Jia Rong;Li Quanlin;Zhang Xiao(Department of Gastrointestinal-Colorectal Surgery,Nanchong Central Hospital Affiliated to North Sichuan Medical College,Nanchong,Sichuan 637100,China)

机构地区：[1]南充市中心医院胃肠外科,四川南充637100

出　　处：《四川医学》2024年第11期1230-1235,共6页Sichuan Medical Journal

基　　金：南充市市级科技计划项目(编号:22YYJCYJ0078,23YYJCYJ0100);四川省基层卫生事业发展研究中心科研课题(编号:SWFZ2C-100)。

摘　　要：目的对比低位直肠癌保肛手术采用延迟结肛吻合与一期吻合的治疗效果。方法检索PubMed、Embase、Web of Science、Cochrane Library、中国知网、万方数据库已公开发表的有关比较低位直肠癌保肛手术延迟结肛吻合与一期吻合近远期疗效的临床研究。提取的数据使用R4.2.0和RevMan 5.3软件进行Meta分析。结果共有14篇文献纳入汇总分析,包括2篇随机对照研究和12篇病例对照研究。总样本量为1079例。包括延迟吻合组495例,一期吻合组584例。汇总结果显示,延迟吻合组术后总体并发症(OR=0.57,95%CI 0.40~0.82,P=0.002)和术后吻合口相关并发症(OR=0.32,95%CI 0.15~0.69,P=0.003)均优于一期吻合组。两组在手术时间、术中出血量和术后1年肛门功能Wexner评分方面差异无统计学意义。结论低位直肠癌采用延迟结肛吻合相比一期吻合+末段回肠预防性造口有利于降低总体并发症和吻合口相关并发症。因此,对于有吻合口漏高危因素的患者可以考虑采用延迟结肛吻合。Objective To compare the effect of delayed coloanal anastomosis versus immediate coloanal anastomosis for low rectal cancer.Methods The databases of PubMed,Embase,Web of Science,Cochrane Library,CNKI,WanFang data were searched to retrieve literature comparing delayed coloanal anastomosis with immediate coloanal anastomosis for low rectal cancer.Data was extracted and analyzed using R4.2.0 and RevMan 5.3 statistical software.Results A total of 14 articles were included,including 2 randomized controlled trials and 12 case-controlled studies,with 1079 patients in total.A total of 495 patients received delayed coloanal anastomosis and 584 patients received immediate coloanal anastomosis.The Meta analysis results showed that:the overall postoperative complication(OR=0.57,95%CI 0.40~0.82,P=0.002),postoperative anastomosis-related complication(OR=0.32,95%CI 0.15~0.69,P=0.003)in delayed anastomosis group were better than those in the immediate anastomois group.There was no statistical difference in the term of operative time,blood loss or Wexner score 1 year after surgery between the two groups.Conclusion Delayed coloanal anastomosis compared with immediate coloanal anastomosis combined with ileostomy for low rectal cancer is beneficial in reducing overall complication and anastomotic-related complications.Therefore,delayed anal anastomosis can be considered for patients with high risk factors for anastomotic leakage.

关 键 词：低位直肠癌 分期拖出式结肠肛管吻合术 一期吻合 META分析 

分 类 号：R657.1[医药卫生—外科学]