Ding Pei-Rong, An Xin, Pan Zhi-Zhong, Wan De-Sen, Fang Yu-Jing, Wu Xiao-Jun, Li Li-Ren, Lu Zhen-Hai
State Key Laboratory of Oncology in South China,Guangdong, Guangzhou, 510060, People's Republic of China.
Ai Zheng. 2009 Jul;28(7):756-61. doi: 10.5732/cjc.008.10805.
Whether selective defunctioning stoma could reduce the rate of anastomotic leak and lessen adverse effects in low anterior resection (LAR) remains controversial. This study was to evaluate the necessity of selective defunctioning stoma after LAR.
Medline databases were searched and English-language articles regarding to selective defunctioning stoma in LAR published from January 1, 1990 to October 1, 2007 were acquired. Seven literatures from seven different studies were included in this study, with total enrollment of 5040 patient. The rate of anastomotic leakage and re-operation rate in different surgical procedures (with or without selective defunctioning stoma) were pooled to compare using meta-analysis.
Selective defunctioning stoma did not significantly reduce the rate of anastomotic leakage after LAR. The pooled odds ratio (OR) was 0.68 (95%CI=0.45-1.02, P>0.05). Selective defunctioning stoma significantly reduced the rate of surgery-required anastomotic leakage following LAR. The pooled OR was 0.33(95% CI=0.25-0.44, P<0.01).
Although selective defunctioning stoma does not reduce the rate of anastomotic leakage, it reduces the rate of surgery-required anastomotic leakage.
选择性去功能造口术能否降低低位前切除术（LAR）的吻合口漏发生率并减轻不良反应仍存在争议。本研究旨在评估LAR术后选择性去功能造口术的必要性。
检索Medline数据库，获取1990年1月1日至2007年10月1日发表的关于LAR中选择性去功能造口术的英文文章。本研究纳入了来自七项不同研究的七篇文献，共纳入5040例患者。采用荟萃分析汇总比较不同手术方式（有或无选择性去功能造口术）的吻合口漏发生率和再次手术率。
选择性去功能造口术并未显著降低LAR术后的吻合口漏发生率。汇总比值比（OR）为0.68（95%可信区间[CI]=0.45 - 1.02，P>0.05）。选择性去功能造口术显著降低了LAR术后需要手术处理的吻合口漏发生率。汇总OR为0.33（95%CI=0.25 - 0.44，P<0.01）。
尽管选择性去功能造口术不能降低吻合口漏发生率，但能降低需要手术处理的吻合口漏发生率。
