Liu Zhihua, Kang Liang, Li Chao, Huang Meijin, Zhang Xingwei, Wang Jianping
Department of Colorectal Surgery, Gastrointestinal Institute of Sun Yat-Sen University, The Sixth Affiliated Hospital of Sun Yat-Sen University (Guangdong Gastrointestinal Hospital), Guangzhou, Guangdong, People's Republic of China.
Surg Laparosc Endosc Percutan Tech. 2014 Feb;24(1):73-9. doi: 10.1097/SLE.0000000000000030.
Left-sided malignant colonic obstruction is one of the most difficult clinical problems, whereas both emergency operations and colonic stenting may have their own advantages and disadvantages. The purpose of this study was to evaluate the complications of colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction.
Medline, Embase, and the Cochrane Library were searched. Only prospective randomized controlled trials that compared the 2 methods were included. Evaluation indexes in our study involved hospital death rates and complications.
No significant difference in either hospital death rates or the overall complications between the 2 groups was found. Heterogeneity analysis found that there was no significant heterogeneity. Removing individual studies from the data editor did not substantially change the RR or the level of heterogeneity of significance for our 2 outcome measures. Testing for publication bias showed that hospital death rates and the overall complications had no serious publication bias.
Colonic stenting was no better than emergency surgery, and should be only used as an alternative to emergency surgery carefully.
左侧恶性结肠梗阻是最棘手的临床问题之一，而急诊手术和结肠支架置入术都各有优缺点。本研究旨在评估结肠支架置入术与急诊手术治疗急性左侧恶性结肠梗阻的并发症。
检索了医学文献数据库（Medline）、荷兰医学文摘数据库（Embase）和考克兰图书馆。仅纳入比较这两种方法的前瞻性随机对照试验。本研究的评估指标包括医院死亡率和并发症。
两组的医院死亡率或总体并发症均无显著差异。异质性分析发现无显著异质性。从数据编辑器中剔除个别研究并未实质性改变我们两个结局指标的相对危险度（RR）或异质性显著水平。发表偏倚检验表明医院死亡率和总体并发症无严重发表偏倚。
结肠支架置入术并不优于急诊手术，应仅谨慎用作急诊手术的替代方案。
