Garg Pankaj Kumar, Goel Aakanksha, Sharma Sneha, Chishi Nilokali, Gaur Manish Kumar
Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi, India.
Department of Surgical Oncology, All India Institute of Medical Sciences, Rishikesh, India.
Visc Med. 2019 Jun;35(3):156-160. doi: 10.1159/000497168. Epub 2019 Mar 27.
With the establishment of the oncological safety and due to the potential of low anterior resection (LAR) with sphincter salvage in improving the quality of life of patients with low and mid rectal cancers, it has become a popular treatment modality. A potential complication of the procedure is anastomotic dehiscence which results in a significant increase in postoperative morbidity and mortality.
A literature search for randomized controlled trials (RCTs) that compared the role of protective diversion stoma with no stoma in LAR of the rectum was performed in PubMed. The effect size for dichotomous and continuous data was displayed as relative risk (RR) and weighted mean difference (WMD), respectively, with their corresponding 95% confidence intervals. A fixed effect or random effects model was used to pool the data according to the result of a statistical heterogeneity test.
Five RCTs were identified and included in the analysis. These yielded 390 patients who had undergone a protective diversion ileostomy at the time of the surgery (LAR) and 378 who had not, resulting in a total of 768 patients, all of whom were included in the meta-analysis. The fashioning of an ileostomy significantly decreased the anastomotic leak (AL) rates (RR 0.33, 95% CI 0.21-0.51, < 0.000) and the reoperation rates (RR 0.26, 95% CI 0.15-0.45, < 0.000).
This meta-analysis found that a protective diversion ileostomy in LAR for rectal cancer decreases the AL rates by one third and the reoperation rates by one fourth. Thus, we conclude that fashioning such a stoma is beneficial.
随着肿瘤学安全性的确立，以及低位前切除术（LAR）保留括约肌在改善低位和中位直肠癌患者生活质量方面的潜力，它已成为一种流行的治疗方式。该手术的一个潜在并发症是吻合口裂开，这会导致术后发病率和死亡率显著增加。
在PubMed上检索比较保护性转流造口与不造口在直肠癌LAR中作用的随机对照试验（RCT）。二分数据和连续数据的效应量分别表示为相对风险（RR）和加权平均差（WMD），并给出相应的95%置信区间。根据统计异质性检验结果，采用固定效应或随机效应模型合并数据。
共纳入5项RCT进行分析。这些研究产生了390例在手术（LAR）时接受保护性转流回肠造口术的患者和378例未接受该手术的患者，总共768例患者，所有患者均纳入荟萃分析。回肠造口术的实施显著降低了吻合口漏（AL）率（RR 0.33，95%CI 0.21 - 0.51，<0.000）和再次手术率（RR 0.26，95%CI 0.15 - 0.45，<0.000）。
这项荟萃分析发现，直肠癌LAR中实施保护性转流回肠造口术可使AL率降低三分之一，再次手术率降低四分之一。因此，我们得出结论，造口是有益的。
