摘要
目的 系统分析影响腹腔镜直肠癌前切除术后吻合口漏发生的危险因素.方法 对2003年8月至2013年8月国内外公开发表的有关腹腔镜直肠癌前切除术后吻合口漏发生危险因素的文献进行Meta分析.数据采用优势比（OR）和95％可信区间（95％ CI）表示,采用x2检验和I2对异质性进行分析,采用固定或随机效应模型合并数据.结果 共纳入文献8篇,包括3 289例直肠癌患者,吻合口漏的发生率为6.050％（199/3 289）.男性腹腔镜直肠癌前切除术患者术后吻合口漏发生风险高于女性（OR =2.17,95％ CI：1.54 ～ 3.06,P＜0.05）;新辅助化疗亦可能增加术后吻合口漏发生风险（OR=1.53,95％ CI：1.00～2.32,P＜0.05）;围手术期输血可能增加术后吻合口漏发生风险（OR=4.80,95％ CI：2.98 ～7.73,P＜0.05）;低位直肠癌较高位直肠癌术后吻合口漏发生风险高（OR=1.60,95％CI：1.14～2.23,P＜0.05）;切割闭合器钉匣数目≥3个增加术后吻合口漏发生风险（OR =0.46,95％CI：0.27 ～0.78,P＜0.05）.而ASA分级、肿瘤浸润深度、淋巴结转移、预防性肠造口与术后吻合口瘘发生风险无关（OR=0.66,0.91,1.25,0.78,95％CI：0.36～1.20,0.55～1.51,0.75 ～2.09,0.50 ～1.23,P＞0.05）.结论 男性、新辅助化疗、围手术期输血、低位直肠癌、切割闭合器钉匣数目≥3个是腹腔镜直肠癌前切除术后吻合口漏发生的主要危险因素.
Objective To investigate the risk factors of anastomotic leakage after laparoscopic anterior resection of rectal cancer.Methods Literatures on the risk factors of laparoscopic anterior resection of rectal cancer were retrieved from August 2003 to August 2013,and then a Meta analysis was carried out based on the data.Data were expressed by odds ratio （OR） and 95％ confidence interval （95％ CI）.The heterogeneity of the data was analyzed using the chi-square test or I2 test.Data were pooled using the fixed or random model.Results Eight literatures including 3 289 patients with rectal cancer were retrieved.The incidence of anastomotic leakage was 6.050％ （199/3 289）.The incidence of anastomotic leakage after laparoscopic anterior resection of rectal cancer in males was significantly higher than females （OR =2.17,95％ CI：1.54-3.06,P ＜0.05）.Neo-adjuvant chemotherapy might increase the risk of postoperative anastomotic leakage （OR =1.53,95％ CI：1.00-2.32,P ＜ 0.05）.Interoperative blood transfusion might increase the risk of postoperative anastomotic leakage （OR =4.80,95％CI：2.98-7.73,P ＜0.05）.Patients with low rectal cancer had greater risk of anastomotic leakage than those with high rectal cancer （OR =1.60,95％ CI：1.14-2.23,P ＜ 0.05）.Number of linear stapler firings greater than 3 increased the risk of postoperative anastomotic leakage （OR =0.46,95％ CI：0.27-0.78,P ＜ 0.05）.The ASA classification of anethesia risk,depth of tumor infiltration,lymph node metastasis,preventive colostomy were not correlated with the incidence of postoperative anastomotic leakage （OR =0.66,0.91,1.25,0.78,95％CI：0.36-1.20,0.55-1.51,0.75-2.09,0.50-1.23,P＞0.05）.Conclusion Male,neo-adjuvant chemotherapy,interoperative blood transfusion,low rectal cancer,number of linear stapler firings greater than 3 are the main risk factors for anastomotic leakage after laparoscopic anterior resection of rectal cancer.
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2014年第7期539-544,共6页
Chinese Journal of Digestive Surgery
