Feng Jin-Shan, Li Jin-Yu, Yang Zheng, Chen Xiu-Yan, Mo Jia-Jie, Li Shang-Hai
Scientific Research Center (Campus Zhanjiang), Guangdong Medical University, Zhanjiang Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha Department of Psychology, Affiliated Hospital of Guangdong Medical University The First Clinical Medical College, Guangdong Medical University, Zhanjiang Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing Department of Cardiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
Medicine (Baltimore). 2018 Apr;97(15):e0315. doi: 10.1097/MD.0000000000010315.
Intestinal anastomosis is an essential step in the intestinal resection in patients with Crohn's disease (CD). Anastomotic configuration such as handsewn end-to-end anastomosis (HEEA), stapled side-to-side anastomosis (SSSA) and so on may be a predictor of prognosis for postoperative CD patients. However, the association between anastomotic types and surgical outcomes are controversial. The aim of this review is to identify the optimal anastomosis for intestinal resection in patients with CD.
Clinical trials comparing anastomosis after intestinal resection in patients with CD were searched in the database of MEDLINE, EMBASE, and the Cochrane Library. Outcomes such as postoperative hospital stay, complications, mortality, recurrence, and reoperation were evaluated. Pairwise treatment effects were estimated through a random-effects network meta-analysis based on the frequency framework by using the STATA software and reported as the estimated summary effect for each comparison between the 2 treatments in the network with a 95% credible interval.
A total of 1113 patients in 11 trials were included. In pair-wise comparisons between groups, for overall postoperative complications, SSSA showed a more probability of superiority to HEEA; for complications other than anastomotic leak, anastomotic leak, wound infection, postoperative hospital stay and mortality, there were no significant difference between groups; for clinical recurrence, SSSA showed a more probability of superiority to HEEA; for reoperation, SSSA showed a more probability of superiority to HEEA. The number of eligible randomized controlled trails (RCTs) was small, and more than half of the included trials were retrospective studies; selection bias may lead to a less power in this assessment; follow-up time between different groups was different, which may possibly have affected the interpretation of the analysis of long-term outcome.
By comprehensive analyzing all the postoperative outcomes, SSSA appeared to be the optimal anastomotic strategy after intestinal resection for patients with CD.
肠道吻合术是克罗恩病（CD）患者肠道切除术中的关键步骤。诸如手工缝合端端吻合术（HEEA）、吻合器侧侧吻合术（SSSA）等吻合方式可能是CD患者术后预后的一个预测指标。然而，吻合方式与手术结局之间的关联存在争议。本综述的目的是确定CD患者肠道切除术中的最佳吻合方式。
在MEDLINE、EMBASE和Cochrane图书馆数据库中检索比较CD患者肠道切除术后吻合术的临床试验。评估术后住院时间、并发症、死亡率、复发率和再次手术等结局。通过使用STATA软件基于频率框架的随机效应网络荟萃分析估计成对治疗效果，并报告为网络中两种治疗之间每次比较的估计汇总效应及95%可信区间。
共纳入11项试验中的1113例患者。在组间成对比较中，对于总体术后并发症，SSSA显示出比HEEA更具优势的可能性；对于吻合口漏以外的并发症、吻合口漏、伤口感染、术后住院时间和死亡率，组间无显著差异；对于临床复发，SSSA显示出比HEEA更具优势的可能性；对于再次手术，SSSA显示出比HEEA更具优势的可能性。符合条件的随机对照试验（RCT）数量较少，且纳入试验中超过一半为回顾性研究；选择偏倚可能导致本评估的效力较低；不同组之间的随访时间不同，这可能影响对长期结局分析的解释。
综合分析所有术后结局，SSSA似乎是CD患者肠道切除术后的最佳吻合策略。
