肠梗阻支架置入术联合新辅助化疗治疗结直肠癌急性肠梗阻的疗效及其预后的Meta分析  

Efficacy and prognosis of colonic stenting combined with neoadjuvant chemotherapy for acute obstructive colorectal cancer:a Meta-analysis

作　　者：梁轩豪 李小荣[1] 李亮[1] 林昌伟[1] Xuanhao Liang;Xiaorong Li;Liang Li;Changwei Lin(Department of Gastrointestinal Surgery,the Third Xiangya Hospital of Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅三医院胃肠外科,长沙410013

出　　处：《中华结直肠疾病电子杂志》2024年第6期472-482,共11页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：湖南省科技创新计划项目(No.2022RC1218);湖南省卫生健康高层次人才重大科研专项资助(No.R2023037);中南大学教育教学改革研究项目(No.2022jy176)。

摘　　要：目的比较肠梗阻支架置入术后行新辅助化疗和择期手术治疗结直肠癌致肠梗阻患者的疗效及其预后。方法检索中国知网、万方和维普文献数据库,收集自建库以来至2024年9月30日期间公开发表的文献,搜集肠梗阻支架置入术后进行新辅助化疗的相关研究,独立筛查文献、提取资料并评价纳入研究的偏倚风险后采用R studio软件进行Meta分析。结果共纳入10篇文献进行Meta分析,“置入肠道支架后联合新辅助化疗后择期行手术”组(后文简称为新辅助治疗组)与“肠道支架置入后联合常规治疗后直接手术”组(后文简称为直接手术组)相比,新辅助治疗组腹腔镜手术率(OR=2.96,95%CI:1.72~5.10)、无病生存率(OR=2.15,95%CI:1.24~3.72)、总生存率(OR=1.92,95%CI:1.06~3.49)均明显高于直接手术组(P<0.05);而在造口率(OR=0.28,95%CI:0.16~0.48)、手术后并发症发生率(OR=0.41,95%CI:0.26~0.66)、局部复发率(OR=0.40,95%CI:0.20~0.82)、术中出血量(SMD=-1.24,95%CI:-2.09~-0.40)、手术后首次排气时间(SMD=-0.60,95%CI:-1.00~-0.21)、手术后住院时间(SMD=-1.12,95%CI:-1.57~-0.67)等方面新辅助治疗组均低于直接手术组(P<0.05)。结论置入肠道支架后联合新辅助化疗后再择期行手术治疗,比肠道支架置入后联合常规治疗后直接手术更加安全和有效。Objective To compare the efficacy and prognosis of neoadjuvant chemotherapy and elective surgery in the treatment of colorectal cancer induced intestinal obstruction after stent implantation.Methods The studies published from the establishment of the database to September 30,2024,were searched from CNKI,Wanfang database,and VIP database.R studio software was used for data analysis.Results A total of 10 studies were included in this meta-analysis.Compared to direct surgery after intestinal stent implantation,elective surgery after intestinal stent implantation combined with neoadjuvant chemotherapy had significant higher laparoscopic surgeryrate(OR=2.96,95%CI:1.72~5.10),diseasefree survival rates(OR=2.15,95%CI:1.24~3.72),and overall survival(OR=1.92,95%CI:1.06~3.49)(P<0.05),and had significant lower ostomy rate(OR=0.28,95%CI:0.16~0.48),post-operative complications rate(OR=0.41,95%CI:0.26~0.66),local recurrence rate(OR=0.40,95%CI:0.20~0.82),intraoperative blood loss(SMD=-1.24,95%CI:-2.09~-0.40),first postoperative exhaust time(SMD=-0.60,95%CI:-1.00~-0.21)and length of stay after surgery(SMD=-1.12,95%CI:-1.57~-0.67)(P<0.05).Conclusion Stent implantation combined with neoadjuvant chemotherapy is safer and more efficient than direct surgery after stent implantation combined with conventional treatment.

关 键 词：结直肠肿瘤 急性肠梗阻 新辅助化疗 肠道支架 META分析 

分 类 号：R73[医药卫生—肿瘤]