Tham Hui Yu, Lim Wen Hui, Jain Sneha Rajiv, Mg Cheng Han, Lin Snow Yunni, Xiao Jie Ling, Foo Fung Joon, Wong Kar Yong, Chong Choon Seng
Department of Surgery, University Surgical Cluster, National University Hospital, Singapore 11759, Singapore.
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 11759, Singapore.
World J Gastrointest Surg. 2021 Apr 27;13(4):379-391. doi: 10.4240/wjgs.v13.i4.379.
The use of intra-operative colonic lavage (IOCL) with primary anastomosis remains controversial in the emergency left-sided large bowel pathologies, with alternatives including Hartmann's procedure, manual decompression and subtotal colectomy.
To compare the peri-operative outcomes of IOCL to other procedures.
Electronic databases were searched for articles employing IOCL from inception till July 13, 2020. Odds ratio and weighted mean differences (WMD) were estimated for dichotomous and continuous outcomes respectively. Single-arm meta-analysis was conducted using DerSimonian and Laird random effects.
Of 28 studies were included in this meta-analysis, involving 1142 undergoing IOCL, and 634 other interventions. IOCL leads to comparable rates of wound infection when compared to Hartmann's procedure, and anastomotic leak and wound infection when compared to manual decompression. There was a decreased length of hospital stay (WMD = -7.750; 95%CI: -13.504 to -1.996; = 0.008) compared to manual decompression and an increased operating time. Single-arm meta-analysis found that overall mortality rates with IOCL was 4% (CI: 0.03-0.05). Rates of anastomotic leak and wound infection were 3% (CI: 0.02-0.04) and 12% (CI: 0.09-0.16) respectively.
IOCL leads to similar rates of post-operative complications compared to other procedures. More extensive studies are needed to assess the outcomes of IOCL for emergency left-sided colonic surgeries.
在急诊左侧大肠病变中，术中结肠灌洗（IOCL）联合一期吻合术的应用仍存在争议，其他选择包括Hartmann手术、手法减压和次全结肠切除术。
比较术中结肠灌洗与其他手术的围手术期结局。
检索电子数据库，查找从开始到2020年7月13日采用术中结肠灌洗的文章。分别对二分法和连续型结局估计比值比和加权平均差（WMD）。采用DerSimonian和Laird随机效应进行单臂荟萃分析。
本荟萃分析纳入28项研究，涉及1142例行术中结肠灌洗者和634例接受其他干预者。与Hartmann手术相比，术中结肠灌洗导致的伤口感染率相当；与手法减压相比，术中结肠灌洗导致的吻合口漏和伤口感染率相当。与手法减压相比，住院时间缩短（WMD = -7.750；95%CI：-13.504至-1.996；P = 0.008），但手术时间延长。单臂荟萃分析发现，术中结肠灌洗的总体死亡率为4%（CI：0.03-0.05）。吻合口漏和伤口感染率分别为3%（CI：0.02-0.04）和12%（CI：0.09-0.16）。
与其他手术相比，术中结肠灌洗导致的术后并发症发生率相似。需要更广泛的研究来评估术中结肠灌洗用于急诊左侧结肠手术的结局。
