Zhao Xiang, Liu Bo, Zhao Ende, Wang Jiliang, Cai Ming, Xia Zefeng, Xia Qinghua, Shuai Xiaoming, Tao Kaixiong, Wang Guobin, Cai Kailin
Gastrointestinal Surgery Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China.
Gastroenterol Res Pract. 2014;2014:407325. doi: 10.1155/2014/407325. Epub 2014 May 14.
Objective. This meta-analysis is aimed at assessing the safety and efficiency of colonic self-expanding metallic stents (SEMS) used as a bridge to surgery in the management of left-sided malignant colonic obstruction (LMCO). Methods. A systematic search was conducted in PubMed, Web of Knowledge, OVID, Google Scholar, CNKI, and WANGFANG for relevant randomized trials comparing colonic stenting used as a bridge in semielective surgery versus emergency surgery from January 2001 to September 2013. Result. Five published studies were included in this systematic review, including 273 patients (140 male/133 female). 136 patients received semielective surgery after SEMS installation while 137 patients underwent emergency surgery without SEMS. SEMS intervention resulted in significantly lower overall colostomy rate (41.9% versus 56.2%, P = 0.02), surgical site infection rate (10.2% versus 19.7%, P = 0.03), and overall complication rate (29.2% versus 60.5%, P = 0.05). There was no statistic difference for the rate of primary anastomosis, anastomotic leak and operation-related mortality between two groups. Conclusions. semielective surgery with SEMS as a bridge for proper patients of LMCO can lower the overall rate for colostomy, surgical site infection, and complications.
目的。本荟萃分析旨在评估结肠自膨式金属支架（SEMS）作为左侧恶性结肠梗阻（LMCO）手术桥梁的安全性和有效性。方法。在PubMed、Web of Knowledge、OVID、谷歌学术、中国知网和万方数据库中进行系统检索，以查找2001年1月至2013年9月期间比较在半择期手术与急诊手术中使用结肠支架作为桥梁的相关随机试验。结果。本系统评价纳入了5项已发表的研究，共273例患者（男性140例/女性133例）。136例患者在安装SEMS后接受半择期手术，137例患者未使用SEMS而接受急诊手术。SEMS干预导致总体结肠造口率显著降低（41.9%对56.2%，P = 0.02）、手术部位感染率显著降低（10.2%对19.7%，P = 0.03）以及总体并发症率显著降低（29.2%对60.5%，P = 0.05）。两组之间的一期吻合率、吻合口漏率和手术相关死亡率无统计学差异。结论。对于合适的LMCO患者，以SEMS作为桥梁进行半择期手术可降低总体结肠造口率、手术部位感染率和并发症发生率。
