结直肠手术中电动与手动圆形吻合器的当前证据：系统评价与荟萃分析。

Current evidence on powered versus manual circular staplers in colorectal surgery: a systematic review and meta-analysis.

作者信息

Martín-Arévalo José, Moro-Valdezate David, Pérez-Santiago Leticia, López-Mozos Fernando, Peña Carlos Javier, Carbonell Asins Juan Antonio, Casado Rodrigo David, García-Botello Stephanie, Gil-Alfosea Claudia, Pla-Martí Vicente

机构信息

Colorectal Surgery Unit, Department of General and Digestive Surgery, Hospital Clínico Universitario de Valencia, Av. Blasco Ibáñez, 17. 46010, Valencia, Spain.

Department of Surgery, University of Valencia, Valencia, Spain.

出版信息

Int J Colorectal Dis. 2025 Jan 15;40(1):13. doi: 10.1007/s00384-025-04807-y.

PURPOSE

This meta-analysis aims to evaluate the efficacy of powered circular staplers (PCS) compared to manual circular staplers (MCS) in reducing anastomotic leakage (AL) and postoperative bleeding (AB) in colorectal surgery.

METHODS

Extensive searches were performed in the Embase, PubMed, and SCOPUS electronic bibliographic databases. Most studies were of an observational nature, and only one randomized clinical trial was identified.

RESULTS

Twelve studies met the inclusion criteria for anastomotic leakage and five for anastomotic hemorrhage. The number of patients included for AL analysis was 4524. The leakage rate was 4.6% (208 cases). The number of patients with AB was 2868 with a bleeding rate of 4.99% (143 patients). After identifying outliers and studies with possible selection bias, the odds ratio (OR) for leaks and PCS was 0.38 (95% CI 0.26-0.55), the relative risk was - 0.05 (95% CI - 0.07 to 0.03), and the number needed to treat to prevent one leak was 20. For bleeding, the PCS OR for PCS was 0.20 (95% CI 0.0772-0.5177).

CONCLUSION

Powered circular staplers could be associated with a significantly lower risk of leakage and anastomotic bleeding than two-row manual circular staplers. Further prospective randomized trials are needed to validate these findings.

目的

本荟萃分析旨在评估电动圆形吻合器（PCS）与手动圆形吻合器（MCS）相比，在降低结直肠手术吻合口漏（AL）和术后出血（AB）方面的疗效。

方法

在Embase、PubMed和SCOPUS电子文献数据库中进行了广泛检索。大多数研究为观察性研究，仅识别出一项随机临床试验。

结果

12项研究符合吻合口漏的纳入标准，5项符合吻合口出血的纳入标准。纳入AL分析的患者数量为4524例。漏率为4.6%（208例）。AB患者数量为2868例，出血率为4.99%（143例）。在识别出异常值和可能存在选择偏倚的研究后，PCS与漏相关的比值比（OR）为0.38（95%CI 0.26 - 0.55），相对风险为 - 0.05（95%CI - 0.07至0.03），预防一例漏所需治疗的患者数量为20例。对于出血，PCS的OR为0.20（95%CI 0.0772 - 0.5177）。