Ye Yingjiang, Jiang Hongpeng
Department of Gastroenterological Surgery, Beijing Key Laboraory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing 100044, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2018;21(4):448-455.
To systematically evaluate the effect of defunctioning stoma, preoperative radiotherapy, and level of inferior mesenteric artery (IMA) ligation on the postoperative anastomotic leakage in rectal cancer by meta-analysis.
Randomized controlled trials (RCT) published before December 2017 regarding the effects of defunctioning stoma, preoperative radiotherapy, and level of inferior mesenteric artery ligation on the postoperative anastomotic leakage in rectal cancer were searched from PubMed, Embase, Scopus, Cochrane Library, CNKI, Wanfang database, meanwhile open data in unpublished trials from clinicaltrials.gov were retrieved. Associated data were screened according to standard and their quality was evaluated strictly. Review manager 5.3 software was used to perform meta-analysis with data. Random effect model based on DerSimonian and Laird method was applied. Heterogenicity among trials was estimated with Chi-square test.
Twenty articles were included in the meta-analysis. The overall incidence of anastomotic leakage was 7.0%(488/7004). The incidence of anastomotic leakage in the defunctioning stoma group and non-defunctioning stoma group was 5.2%(24/459) and 17.3%(77/445) respectively. The incidence of anastomotic leakage in the radiotherapy group and non-radiotherapy group was 6.5%(188/2900) and 6.1%(179/2946) respectively. The incidences of anastomotic leakage in the low and high IMA ligation groups was 4.7%(6/129) and 11.2%(14/125) respectively. Meta-analysis showed that the incidence in defunctioning stoma group was significantly lower than that in non-defunctioning stoma group (RR:0.33, 95%CI:0.21-0.50, P<0.00001); the incidences between radiotherapy group and non-radiotherapy (RR:1.05, 95%CI: 0.80-1.38, P=0.72), and between low IMA ligation group and high IMA ligation group (RR:0.50, 95%CI:0.20-1.23, P=0.13) were not significantly different. Funnel figure drawn with RCTs about defunctioning stoma and preoperative radiotherapy revealed no significant publication bias existed within included studies.
Defunctioning stoma can effectively prevent the occurrence of postoperative anastomotic leakage, whereas the preoperative radiotherapy and high IMA ligation may not increase the risk of anastomotic leakage.
通过荟萃分析系统评价造口旷置、术前放疗及肠系膜下动脉（IMA）结扎水平对直肠癌术后吻合口漏的影响。
从PubMed、Embase、Scopus、Cochrane图书馆、中国知网、万方数据库检索2017年12月以前发表的关于造口旷置、术前放疗及IMA结扎水平对直肠癌术后吻合口漏影响的随机对照试验（RCT），同时检索clinicaltrials.gov未发表试验中的公开数据。按照标准筛选相关数据并严格评估其质量。采用Review manager 5.3软件对数据进行荟萃分析。应用基于DerSimonian和Laird方法的随机效应模型。用卡方检验估计各试验间的异质性。
荟萃分析纳入2０篇文章。吻合口漏的总发生率为7.0%（488/7004）。造口旷置组和非造口旷置组吻合口漏发生率分别为5.2%（２４/459）和17.3%（77/445）。放疗组和非放疗组吻合口漏发生率分别为6.5%（188/2900）和6.1%（179/2946）。IMA低位结扎组和高位结扎组吻合口漏发生率分别为4.7%（6/129）和11.2%（14/125）。荟萃分析显示，造口旷置组发生率显著低于非造口旷置组（RR：0.33，95%CI：0.21-0.50，P<0.00001）；放疗组与非放疗组（RR：1.05，95%CI：0.80-1.38，P=0.72）以及IMA低位结扎组与高位结扎组（RR：0.50，95%CI：0.20-1.23，P=0.13）之间发生率差异无统计学意义。绘制的关于造口旷置和术前放疗的RCT漏斗图显示纳入研究中无明显发表偏倚。
造口旷置可有效预防术后吻合口漏的发生，而术前放疗和IMA高位结扎可能不会增加吻合口漏的风险。
Zotero 插件