Choy P Y G, Bissett I P, Docherty J G, Parry B R, Merrie A E H
Cochrane Database Syst Rev. 2007 Jul 18(3):CD004320. doi: 10.1002/14651858.CD004320.pub2.
Ileocolic anastomoses are commonly performed for right-sided colon cancer and Crohn's disease. The anastomosis may be constructed using a linear cutter stapler or by suturing. Individual trials comparing stapled versus handsewn ileocolic anastomoses have found little difference in the complication rate but they have lacked adequate power to detect potential small difference. To our knowledge, this is the first systematic review specifically investigating ileocolic anastomosis.
To compare outcomes of ileocolic anastomoses performed using stapling and handsewn techniques. The hypothesis tested was that the stapling technique is associated with fewer complications.
MEDLINE, EMBASE, Cochrane Colorectal Cancer Group specialised register SR-COLOCA, Cochrane Library were searched for randomised controlled trials comparing use of a linear cuter stapler with any type of suturing technique for ileocolic anastomoses in adults from 1970 to 2005. Abstracts presented to the following society meetings between 1970 and 2002 were handsearched: American Society of Colon and Rectal Surgeons, the Association of Coloproctology of Great Britain and Ireland, European Association of Coloproctology.
Randomised controlled trials comparing use of linear cutter stapler (isoperistaltic side to side or functional end to end) with any type of suturing technique in adults.
Eligible studies were selected and their methodological quality assessed. Relevant results were extracted and missing data sought from the authors. RevMan 4.2 Analysis version 1.0.5 was used to perform meta-analysis when there were sufficient data. Sub-group analyses for cancer and inflammatory bowel disease as indication for ileocolic anastomoses were performed.
After obtaining individual data from authors for studies that include other anastomoses, six trials (including one unpublished) with 955 ileocolic participants (357 stapled, 598 handsewn) were included. The three largest trials had adequate allocation concealment. Stapled anastomosis was associated with significantly fewer anastomotic leaks compared with handsewn (S=5/357, HS=36/598, OR 0.34 [0.14, 0.82] p=0.02). One study performed routine radiology to detect asymptomatic leaks. For the sub-group of 825 cancer patients in four studies, stapled anastomosis led to significant fewer anastomotic leaks (S=4/300, HS=35/525, OR 0.28 [0.10, 0.75] p=0.01). There were too few Crohn's disease patients to perform sub-group analysis. All other outcomes: stricture, anastomotic haemorrhage, anastomotic time, re-operation, mortality, intra-abdominal abscess, wound infection, length of stay, showed no significant difference.
AUTHORS' CONCLUSIONS: Stapled functional end to end ileocolic anastomosis is associated with fewer leaks than handsewn anastomosis.
回结肠吻合术常用于右侧结肠癌和克罗恩病的治疗。吻合可使用直线切割吻合器或缝合完成。比较吻合器吻合与手工缝合回结肠吻合术的个别试验发现，并发症发生率差异不大，但缺乏足够的检验效能来检测潜在的微小差异。据我们所知，这是首次专门针对回结肠吻合术的系统评价。
比较使用吻合器技术与手工缝合技术进行回结肠吻合术的结果。所检验的假设是，吻合器技术的并发症较少。
检索了MEDLINE、EMBASE、Cochrane结直肠癌组专业注册库SR-COLOCA和Cochrane图书馆，以查找1970年至2005年期间比较直线切割吻合器与任何类型缝合技术用于成人回结肠吻合术的随机对照试验。对1970年至2002年期间以下学会会议上发表的摘要进行了手工检索：美国结直肠外科医师学会、大不列颠及爱尔兰结直肠病学会、欧洲结直肠病学会。
比较直线切割吻合器（顺蠕动侧侧吻合或功能性端端吻合）与任何类型缝合技术用于成人的随机对照试验。
选择符合条件的研究并评估其方法学质量。提取相关结果并向作者索取缺失数据。当有足够数据时，使用RevMan 4.2分析版本1.0.5进行荟萃分析。对以癌症和炎症性肠病作为回结肠吻合术指征的亚组进行了分析。
在从作者处获取了包括其他吻合术的研究的个体数据后，纳入了6项试验（包括1项未发表的试验），共955例接受回结肠吻合术的参与者（357例使用吻合器，598例手工缝合）。三项最大的试验有充分的分配隐藏。与手工缝合相比，吻合器吻合的吻合口漏显著减少（吻合器组5/357，手工缝合组36/598，OR 0.34 [0.14, 0.82]，p = 0.02）。一项研究进行了常规放射学检查以检测无症状漏。在四项研究中的825例癌症患者亚组中，吻合器吻合导致的吻合口漏显著减少（吻合器组4/300，手工缝合组35/525，OR 0.28 [0.10, 0.75]，p = 0.01）。克罗恩病患者太少，无法进行亚组分析。所有其他结果：狭窄、吻合口出血、吻合时间、再次手术、死亡率、腹腔内脓肿、伤口感染、住院时间，均无显著差异。
功能性端端回结肠吻合器吻合比手工缝合吻合的漏更少。
