腹腔镜下直肠癌前切除术预防性肠造瘘价值的Meta分析
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摘要
目的探讨预防性肠造瘘在腹腔镜直肠癌前切除术中的价值。方法检索国内外有关腹腔镜直肠癌前切除术中实施预防性肠造瘘的相关研究和文献进行Meta分析。结果共纳入文献16篇。造瘘组发生吻合口瘘86例;非造瘘组吻合口瘘236例;造瘘组吻合口瘘发生率(OR=0.45,95%CI:0.28～0.72,P<0.05)低于非造瘘组;两组围手术期再手术率及切口感染率无明显统计学差异。结论腹腔镜下直肠癌前切除术行预防性肠造瘘可有效降低术后吻合口瘘及术后腹膜炎的发生率,但对于降低围手术期再手术率及切口感染率效果不明确。
Objective To investigate the value of preventive stoma in laparoscopic rectal anterior resection. Methods Metaanalysis was conducted by retrieving relevant research and literature on preventive enterostomy in laparoscopic anterior resection of rectal cancer at home and abroad. Results A total of 16 studies were included. 86 cases of anastomotic leakage were occured in ostomy group; 236 cases in the group of non-ostomy occur anastomotic leakage; ostomy group anastomotic leakage ratio(OR=0.45, 95% CI:0.28～0.72, P<0.05) lower than non-ostomy group:There were no differences in reoperation rate and wound infection rate. Conclusion Laparoscopic rectal anterior resection can effectively reduce anastomotic leakage rate and peritonitis rate, but the effect is not clear in reduce reoperation rate and wound infection rate.
Objective To investigate the value of preventive stoma in laparoscopic rectal anterior resection. Methods Metaanalysis was conducted by retrieving relevant research and literature on preventive enterostomy in laparoscopic anterior resection of rectal cancer at home and abroad. Results A total of 16 studies were included. 86 cases of anastomotic leakage were occured in ostomy group; 236 cases in the group of non-ostomy occur anastomotic leakage; ostomy group anastomotic leakage ratio(OR=0.45, 95% CI:0.28～0.72, P<0.05) lower than non-ostomy group:There were no differences in reoperation rate and wound infection rate. Conclusion Laparoscopic rectal anterior resection can effectively reduce anastomotic leakage rate and peritonitis rate, but the effect is not clear in reduce reoperation rate and wound infection rate.
引文
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[11]张展志,肖萌萌,李雁,等.腹腔镜直肠癌保肛手术后吻合口瘘的危险因素与对策[J].中华肿瘤防治杂志,2016,23(1):40-44.
[12]洪驷耿,李邓松,刘金炎.腹腔镜辅助低位直肠癌预防性回肠造口的效果[J].中国医药科学,2016,6(24):195-197.
[13]Boyce SA,Harris C,Stevenson A,et al.Management of Low Colorectal Anastomotic Leakage in the Laparoscopic Era[J].Diseases of the Colon&Rectum,2017,60(8):807-814.
[14]Shimizu H,Yamaguchi S.Temporary ileostomy with laparoscopic low anterior resection in rectal cancer patients[J].Surgical Endoscopy and Other Interventional Techniques,2017,31(Supplement 1):S181.
[15]Mahtab Zanguie,Abbas Abdollahi,Roham Salek,et al.Three Anastomotic Techniques Following Laparoscopic Rectal Cancer Resection:Our Experience in 155 Patients[J].Surgical Innovation,2018,25(1):57-61.
[16]蔡泽贤.腹腔镜直肠癌前切除术后吻合口瘘的危险因素及预防[J].中国现代普通外科进展,2018,21(2):144-146.
[17]Mustafa Haksal,Nuri Okkabaz,Ali Emre Atici,et al.Fortune of temporary ileostomies in patients treated with laparoscopic low anterior resection for rectal cancer[J].Ann Surg Treat Res 2017,92(1):35-41.
[2]Tayfun Karahasanoglu,Ismail Hamzaoglu,Bilgi Baca,et al.Evaluation of Diverting Ileostomy in Laparoscopic Low Anterior Resection for Rectal Cancer[J].Asian J Surg,2011,34(2):63-68.
[3]Sartori CA,Pozzo AD,Franzato B,et al.Laparoscopic total mesorectal excision for rectal cancer:experience of a single center with a series of 174patients[J].Surgical Endoscopy,2011,25(2):508-514.
[4]Park JS,Choi GS,Kim SH,et al.Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision:the Korean laparoscopic colorectal surgery study group[J].Annals of Surgery,2013,257(4):665-671.
[5]王道荣,李清国.腹腔镜超低位直肠癌根治保肛术68例疗效分析[J].中华普外科手术学杂志(电子版),2013,7(2):22-24.
[6]黄文辉,林龙,侯开庆.改良襻式回肠末端造瘘在腹腔镜直肠癌手术中的应用价值[J].世界华人消化杂志,2014(21):3170-3173.
[7]杨卫华,高愫,张松柏.选择性预防末端回肠造瘘在腹腔镜低位直肠癌保肛手术中的应用价值[J].腹腔镜外科杂志,2014,19(7):509-511.
[8]陈健健.预防回肠造瘘在腹腔镜直肠癌根治手术中应用体会[J].泰山医学院学报,2014,36(8):821-822.
[9]李爽.腹腔镜直肠癌前切除术后吻合口瘘的影响因素分析[J].保健医学研究与实践,2014,11(4):22-25.
[10]Francesco Saverio Mari,Tatiana Di Cesare,Luciano Novi,et al.Does ghost ileostomy have a role in the laparoscopic rectal surgery era?A randomized controlled trial[J].Surgical Endoscopy,2015,29(9):2590-2597.
[11]张展志,肖萌萌,李雁,等.腹腔镜直肠癌保肛手术后吻合口瘘的危险因素与对策[J].中华肿瘤防治杂志,2016,23(1):40-44.
[12]洪驷耿,李邓松,刘金炎.腹腔镜辅助低位直肠癌预防性回肠造口的效果[J].中国医药科学,2016,6(24):195-197.
[13]Boyce SA,Harris C,Stevenson A,et al.Management of Low Colorectal Anastomotic Leakage in the Laparoscopic Era[J].Diseases of the Colon&Rectum,2017,60(8):807-814.
[14]Shimizu H,Yamaguchi S.Temporary ileostomy with laparoscopic low anterior resection in rectal cancer patients[J].Surgical Endoscopy and Other Interventional Techniques,2017,31(Supplement 1):S181.
[15]Mahtab Zanguie,Abbas Abdollahi,Roham Salek,et al.Three Anastomotic Techniques Following Laparoscopic Rectal Cancer Resection:Our Experience in 155 Patients[J].Surgical Innovation,2018,25(1):57-61.
[16]蔡泽贤.腹腔镜直肠癌前切除术后吻合口瘘的危险因素及预防[J].中国现代普通外科进展,2018,21(2):144-146.
[17]Mustafa Haksal,Nuri Okkabaz,Ali Emre Atici,et al.Fortune of temporary ileostomies in patients treated with laparoscopic low anterior resection for rectal cancer[J].Ann Surg Treat Res 2017,92(1):35-41.