腹腔镜右半结肠切除术中体内与体外吻合术：随机对照试验的最新系统评价和荟萃分析
Intracorporeal versus Extracorporeal Anastomosis in Laparoscopic Right Hemicolectomy: An Updated Systematic Review and Meta-Analysis of Randomized Control Trials.
作者信息
Wei Pengyu, Li Yang, Gao Jiale, Wu Si, Shu Wenlong, Yao Hongwei, Zhang Zhongtao
机构信息
Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China,
Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China.
出版信息
Dig Surg. 2024;41(5-6):224-244. doi: 10.1159/000541373. Epub 2024 Sep 27.
INTRODUCTION
Laparoscopic right hemicolectomy has become the standard surgical procedure for the treatment of right colon disease; however, the choice of anastomosis remains controversial. This study aimed to compare the safety and efficacy of intracorporeal anastomosis and extracorporeal anastomosis in laparoscopic right hemicolectomy.
METHODS
A systematic literature search was performed in PubMed, Embase, Web of Science, and Cochrane Library. Randomized controlled trials that compared intracorporeal anastomosis with extracorporeal anastomosis in patients with laparoscopic right hemicolectomy until June 4, 2023, are selected. The primary outcomes measured were incidence of anastomotic leakage within 30 days post-operation. Statistical analyses were performed using Review Manager (version 5.4.1).
RESULTS
Seven RCTs, including 720 patients, were eligible for the meta-analysis. The incidence of anastomotic leakage showed no significant difference between the intracorporeal anastomosis group and the extracorporeal anastomosis group (RR 0.93, 95% CI: 0.49, 1.76, p = 0.83, and I2 = 0%). However, the intracorporeal anastomosis group had significantly lower rates of postoperative ileus (RR 0.67, 95% CI: 0.45-0.99, p = 0.04, I2 = 46%) and surgical site infections (RR 0.34, 95% CI: 0.16-0.74, p = 0.007, I2 = 0%) compared to the extracorporeal anastomosis group. Additionally, patients in the intracorporeal anastomosis group experienced earlier postoperative passage of gas and stool (WMD -0.39, 95% CI: -0.60, -0.19, p = 0.0002, and I2 = 67%; WMD -0.53, 95% CI: -0.85, -0.21, p = 0.001, and I2 = 75%), as well as shorter hospital stays (WMD -0.46, 95% CI: -0.74, -0.18, p = 0.001, and I2 = 34%).
CONCLUSION
In laparoscopic right hemicolectomy, intracorporeal anastomosis does not increase the incidence of anastomotic leakage within 30 days post-operation compared to extracorporeal anastomosis. In addition, intracorporeal anastomosis resulted in faster recovery of bowel function. This suggests that intracorporeal anastomosis is safe and effective.
引言
腹腔镜右半结肠切除术已成为治疗右半结肠疾病的标准手术方式；然而，吻合方式的选择仍存在争议。本研究旨在比较腹腔镜右半结肠切除术中体内吻合与体外吻合的安全性和有效性。
方法
在PubMed、Embase、Web of Science和Cochrane图书馆进行系统的文献检索。选取截至2023年6月4日，比较腹腔镜右半结肠切除术患者体内吻合与体外吻合的随机对照试验。主要观察指标为术后30天内吻合口漏的发生率。使用Review Manager（5.4.1版）进行统计分析。
结果
七项随机对照试验，共720例患者，符合荟萃分析的纳入标准。体内吻合组与体外吻合组的吻合口漏发生率无显著差异（风险比0.93，95%可信区间：0.49，1.76，p = 0.83，I² = 0%）。然而，与体外吻合组相比，体内吻合组术后肠梗阻发生率（风险比0.67，95%可信区间：0.45 - 0.99，p = 0.04，I² = 46%）和手术部位感染发生率（风险比0.34，95%可信区间：0.16 - 0.74，p = 0.007，I² = 0%）显著更低。此外，体内吻合组患者术后排气和排便时间更早（平均差 -0.39，95%可信区间： -0.60， -0.19，p = 0.0002，I² = 67%；平均差 -0.53，95%可信区间： -0.85， -0.21，p = 0.001，I² = 75%），住院时间也更短（平均差 -0.46，95%可信区间： -0.74， -0.18，p = 0.001，I² = 34%）。
结论
在腹腔镜右半结肠切除术中，与体外吻合相比，体内吻合在术后30天内并未增加吻合口漏的发生率。此外，体内吻合可使肠道功能恢复更快。这表明体内吻合是安全有效的。
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