经肛门局部切除直肠肿瘤后是否应关闭直肠缺损？系统评价和荟萃分析。
Should the rectal defect be closed following transanal local excision of rectal tumors? A systematic review and meta-analysis.
机构信息
Department of Digestive Surgery, Caen University Hospital, Avenue de la Côte de Nacre, 14032, Caen Cedex, France.
UMR, French National Institute for Health and Medical Research U1086 Cancer and Prevention, The François Baclesse Center, Caen, France.
出版信息
Tech Coloproctol. 2017 Dec;21(12):929-936. doi: 10.1007/s10151-017-1714-9. Epub 2017 Nov 13.
BACKGROUND
Transanal local excision (TLE) has become the treatment of choice for benign and early-stage selected malignant tumors. However, closure of the rectal wall defect remains a controversial point and the available literature still remains unclear. Our aim was to determine through a systematic review of the literature and a meta-analysis of relevant studies whether or not the wall defect following TLE of rectal tumors should be closed.
METHODS
Medline and the Cochrane Trials Register were searched for trials published up to December 2016 comparing open versus closed management of the surgical rectal defect after TLE of rectal tumors. Meta-analysis was performed using Review Manager 5.0.
RESULTS
Four studies were analyzed, yielding 489 patients (317 in the closed group and 182 in the open group). Meta-analysis showed no significant difference between the closed and open groups regarding the overall morbidity rate (OR 1.26; 95% CI 0.32-4.91; p = 0.74), postoperative local infection rate (OR 0.62; 95% CI 0.23-1.62; p = 0.33), postoperative bleeding rate (OR 0.83; 95% CI 0.29-1.77; p = 0.63), and postoperative reintervention rate (OR 2.21; 95% CI 0.52-9.47; p = 0.29).
CONCLUSIONS
This review and meta-analysis suggest that there is no difference between closure or non-closure of wall defects after TLE.
背景
经肛门局部切除术（TLE）已成为治疗良性和早期选择的恶性肿瘤的首选方法。然而，直肠壁缺损的闭合仍然存在争议，现有文献仍不清楚。我们的目的是通过对文献进行系统评价和对相关研究进行荟萃分析来确定，TLE 切除直肠肿瘤后，是否应该闭合直肠壁缺损。
方法
检索 Medline 和 Cochrane 试验登记处，以获取截至 2016 年 12 月比较 TLE 切除直肠肿瘤后开放与闭合直肠缺损管理的试验。使用 Review Manager 5.0 进行荟萃分析。
结果
分析了 4 项研究，共纳入 489 例患者（闭合组 317 例，开放组 182 例）。荟萃分析显示，两组之间总发病率（OR 1.26；95%CI 0.32-4.91；p=0.74）、术后局部感染率（OR 0.62；95%CI 0.23-1.62；p=0.33）、术后出血率（OR 0.83；95%CI 0.29-1.77；p=0.63）和术后再次干预率（OR 2.21；95%CI 0.52-9.47；p=0.29）无显著差异。
结论
本综述和荟萃分析表明，TLE 切除直肠肿瘤后，闭合或不闭合壁缺损之间没有差异。
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