摘要
目的对于急性梗阻性左半结肠癌,肠道支架联合择期手术是一种方案选择,但对支架的应用价值至今存在争议。本文旨在评价支架联合择期手术相较急诊手术在梗阻性左半结肠癌应用的安全性和有效性。方法对PUBMED、MEDLINE、EMBASE、OVID、Cochrane图书馆、万方、维普等数据库进行文献检索,纳入对比分析肠道支架联合择期手术与急诊手术在治疗梗阻性左半结肠癌的随机对照临床实验(RCT)。主要结局指标包括永久造口率、一期吻合率,次要结局指标为总并发症发生率、吻合口瘘发生率、腹腔内感染率、手术切口感染率(SSI)、死亡率、复发率。结果经过筛查后共纳入9项随机对照临床研究包含564例病人,其中支架组279例,285例行急诊手术;支架组中成功安置支架并有效缓解梗阻达80.28%(224例)。相较于急诊手术,支架序贯择期手术在永久造口率(RR=0. 73,95%CI:0.56-0.94)、一期吻合率(RR=1.34,95%CI:1.05-1.71)、总体并发生症发生率(RR=0.57,95%CI:0.37-0.86)、手术切口感染率(RR=0.43,95%CI:0.25-0.73)等方面有明显获益。两组之间吻合口瘘发生率(RR=0.85,95%CI:0.42-1.71)、腹腔感染率(RR=0.86,95%CI:0.32-2.30)、死亡率(RR=0.85,95%CI:0.42-1.71)、肿瘤复发率(RR=1.19,95%CI:0.87-1.63,P=0.27)无明显差异。结论肠道支架序贯择期手术治疗梗阻性左半结肠癌安全、可行,支架应用明显提高患者一期吻合率,降低永久造口率及并发症率。
Objective As an alternative choice for the treatment of symptomatic left-sided malignant colonic obstruction, the debate is still open about the role of the self-expandable metallic stent placement as a bridge to elective surgery compared with the emergency operation. The purpose of this paper is to evaluate the efficacy and safety of colonic stenting as a bridge to surgery versus emergency surgery for left-sided malignant colonic obstruction. Methods Randomized clinical trials that compared the efficacy and safety of preoperative colonic stenting versus emergency operation for left-sided malignant colonic obstruction were identified seperately by two authors in medical databases including PUBMED, MEDLINE, EMBASE, OVID and the Cochrane Library, WanFang, WeiPu database. The primary outcomes included the primary anastomosis rate and permanent stoma rate, and the secondery outcomes were the permanent stoma rate, the morbidity rate, the anastomotic leakage rate, the intraabd-ominal infection rate, the surgical site infectionM the mortality rate and the tumor recurrence rate. Results All nine RCTs with 564 patients consisting of 279 in the stent group and 285 in the emergency group were included in the analysis. The clinical success of the stent for the palliation of the obstruction symptom was 80.28%（224）. The colonic stent use resulted in significantly lower permanent stoma （RR=0.73, 95%CI： 0.56-0.94）, higher primary anastomosis （RR= 1.34, 95%CI： 1.05- 1.71）, lower overall morbidity rate （RR= 0.57, 95% CI： 0.37-0.86） and lower surgical site infection （RR= 0.43, 95% CI： 0.25-0.73）. But there was no significant difference between the two groups in anastomotic leakage rate（ RR = 0.85, 95 % CI： 0.42 - 1.71）, intra- abdominal infection （ RR = 0.86, 95 % CI： 0.32- 2.30）,mortality rate（RR=0.85, 95% CI： 0.42-1.71） or the tumor recurrence rate （RR= 1.19, 95% CI： 0.87-1.63, P=0.27） .Conclnsions Colonic stents serve as a safe and effective bridge to subsequent surgery in patients with obstructed left-sided colon cancer. STENT was associated with higher primary anastomosis and lower lower permanent stoma.
作者
彭孟寅
刘见
杨晓波
袁远洪
张敬麟
吴淼
PENG Meng-Yin;LIU Jian;YANG Xiao-Bo;YUAN Yuan-Hong;ZHANGJin-Lin;WU Miao(The SouthWest Medical University,LuZhou 646000,China)
出处
《现代消化及介入诊疗》
2018年第5期564-571,共8页
Modern Interventional Diagnosis and Treatment in Gastroenterology
