Gachabayov M, Tuech J J, Tulina I, Coget J, Bridoux V, Bergamaschi R
Section of Colorectal Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, USA.
Department of Digestive Surgery, Rouen University Hospital, Rouen Cedex, France.
Colorectal Dis. 2020 Oct;22(10):1245-1257. doi: 10.1111/codi.15016. Epub 2020 Mar 17.
The aim of this meta-analysis was to comparatively evaluate the outcomes of primary anastomosis (PRA) and nonrestorative resection (NRR) as emergency surgery and ostomy reversal in patients with perforated diverticulitis and peritonitis.
PubMed, MEDLINE via Ovid, Embase, CINAHL, Cochrane Library and Web of Science databases were systematically searched. Postoperative morbidity following emergency resection was the primary end-point. Quality assessment of the included studies was performed using the Cochrane Quality Assessment Tool including recruitment bias and crossover with intention-to-treat analysis. The Haenszel-Mantel method with odds ratios (OR, 95% CI) and the inverse variance method with mean difference (MD, 95% CI) as effect measures were utilized for dichotomous and continuous outcomes, respectively.
Four randomized controlled trials totaling 382 patients (180 PRA vs 204 NRR) were included. Morbidity rates following emergency resection did not differ (OR = 0.99, 95% CI 0.65, 1.51; P = 0.95; number needed to treat/harm (NNT) 96). Organ/space surgical site infection rates were 3.3% in PRA vs 11.3% in NRR (OR = 0.29, 95% CI 0.12, 0.74; P = 0.009; NNT = 13). Postoperative morbidity rates following ostomy reversal were significantly lower in PRA (OR = 0.31, 95% CI 0.15, 0.64; P = 0.001; NNT = 7). Pooled ostomy non-reversal rates were 16% in PRA vs 35.5% in NRR (OR = 0.37, 95% CI 0.22, 0.62; P = 0.0001; NNT = 6) with high heterogeneity (I = 63%; τ = 8.17). Meta-regression analysis revealed significant negative correlation between the PRA-to-NRR crossover rate and the ostomy non-reversal rate (P = 0.029).
This meta-analysis found that PRA was associated with better short- and long-term outcomes at the cost of significantly longer operating time at emergency surgery.
本荟萃分析旨在比较评估一期吻合术（PRA）和非恢复性切除术（NRR）作为穿孔性憩室炎和腹膜炎患者急诊手术及造口回纳术的疗效。
系统检索了PubMed、通过Ovid检索的MEDLINE、Embase、CINAHL、Cochrane图书馆和Web of Science数据库。急诊切除术后的术后发病率是主要终点。使用Cochrane质量评估工具对纳入研究进行质量评估，包括招募偏倚和意向性治疗分析中的交叉情况。分别采用带比值比（OR，95%可信区间）的Haenszel-Mantel方法和带均数差（MD，95%可信区间）的逆方差方法作为二分类和连续性结局的效应量。
纳入了4项随机对照试验，共382例患者（180例行PRA，204例行NRR）。急诊切除术后的发病率无差异（OR = 0.99，95%可信区间0.65，1.51；P = 0.95；治疗/伤害所需人数（NNT）96）。PRA组的器官/腔隙手术部位感染率为3.3%，NRR组为11.3%（OR = 0.29，95%可信区间0.12，0.74；P = 0.009；NNT = 13）。PRA组造口回纳术后的术后发病率显著更低（OR = 0.31，95%可信区间0.15，0.64；P = 0.001；NNT = 7）。PRA组合并的造口未回纳率为16%，NRR组为35.5%（OR = 0.37，95%可信区间0.22，0.62；P = 0.0001；NNT = 6），异质性较高（I² = 63%；τ² = 8.17）。Meta回归分析显示PRA与NRR交叉率和造口未回纳率之间存在显著负相关（P = 0.029）。
本荟萃分析发现，PRA与更好的短期和长期结局相关，但代价是急诊手术的手术时间显著延长。
