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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2019, Vol. 13 ›› Issue (06) : 496 -504. doi: 10.3877/cma.j.issn.1674-0793.2019.06.018

所属专题： 文献；

循证医学

一期手术与二期手术治疗先天性巨结肠的Meta分析
谢崇1, 李水学1,†(), 和军1, 刘妍芳1, 阿不地合比尔·阿不拉1   
  1. 1. 830001　乌鲁木齐，新疆维吾尔自治区人民医院小儿外科
  • 收稿日期:2019-02-28 出版日期:2019-12-01
  • 通信作者: 李水学

One-stage versus two-stage surgery for the treatment of Hirschsprung’s disease: A Meta-analysis

Chong Xie1, Shuixue Li1,†(), Jun He1, Yanfang Liu1, Abudihebier Abula1   

  1. 1. Department of Pediatric Surgery, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China
  • Received:2019-02-28 Published:2019-12-01
  • Corresponding author: Shuixue Li
  • About author:
    Corresponding author: Li Shuixue, Email:
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谢崇, 李水学, 和军, 刘妍芳, 阿不地合比尔·阿不拉. 一期手术与二期手术治疗先天性巨结肠的Meta分析[J]. 中华普通外科学文献(电子版), 2019, 13(06): 496-504.

Chong Xie, Shuixue Li, Jun He, Yanfang Liu, Abudihebier Abula. One-stage versus two-stage surgery for the treatment of Hirschsprung’s disease: A Meta-analysis[J]. Chinese Archives of General Surgery(Electronic Edition), 2019, 13(06): 496-504.

目的

比较一期手术和二期手术治疗先天性巨结肠（HD）的术后并发症及排便功能。

方法

通过检索Pubmed、Web of Science、中国知网、万方中文数据库，筛选出2018年6月之前发表的符合标准的一期手术与二期手术治疗HD的对比研究。应用STATA 14.0软件对纳入文献的相关数据进行Meta分析，同时对纳入文献进行发表偏倚检验及敏感性分析。

结果

共筛选出10篇文献633例患者，包括9篇英文和1篇中文回顾性对比研究。Meta分析结果显示：在术后并发症方面，一期手术组与二期手术组在吻合口狭窄（OR=0.56，95% CI：0.29~1.09，P=0.087）、吻合口瘘（OR=1.01，95% CI：0.16~6.51，P=0.995）、肠梗阻（OR=0.88，95% CI：0.44~1.75，P=0.708）、直肠脱垂（OR=1.29，95% CI：0.35~4.82，P=0.705）、手术部位感染（OR=0.61，95% CI：0.31~1.20，P=0.152）、再次手术（OR=1.19，95% CI：0.66~2.16，P=0.563）的发生率比较，差异均无统计学意义，而二期手术组的术后小肠结肠炎（HAEC）发生率明显低于一期手术组（OR=2.09，95% CI：1.34~3.25，P=0.001）。在排便功能方面，两组术后排便功能良好率（OR=1.08，95% CI：0.58~2.01，P=0.804）、污粪（OR=0.60，95% CI：0.26~1.42，P=0.249）和大便失禁（OR=0.52，95% CI：0.17~1.55，P=0.237）的发生率比较，差异均无统计学意义，但一期手术组术后便秘发生率显著低于二期手术组（OR=0.49，95% CI：0.30~0.81，P=0.006）。

结论

一期手术治疗HD避免了二期手术相关的吻合口并发症，而且便秘的发生率明显低于二期手术，但是HAEC发生率明显高于二期手术。

关键词: Hirschsprung病, 结直肠外科手术, Meta分析, 一期手术, 二期手术
Objective

To compare the postoperative complications and defecation function in patients with Hirschsprung’s disease (HD) treated with one-stage surgery (OS) and two-stage surgery (TS).

Methods

By searching Pubmed, Web of Science, CNKI, Wanfang databases, a comparative study of OS and TS surgical treatment of HD published before June 2018 was screened out. The relevant data in the included literature, publication bias and sensitivity were analyzed using STATA 14.0 software.

Results

Ten articles including 633 cases, nine English studies and one Chinese retrospective comparative study were retrieved. In terms of postoperative complications, there were no significant differences in the incidence of anastomotic stricture (OR=0.56, 95% CI: 0.29-1.09, P=0.087), anastomotic fistula (OR=1.01,95% CI: 0.16-6.51, P=0.995), intestinal obstruction (OR=0.88, 95% CI: 0.44-1.75, P=0.708), rectal prolapse (OR=1.29, 95% CI: 0.35-4.82, P=0.705), surgical site infection (OR=0.61, 95% CI: 0.31-1.20,P=0.152) and reoperation (OR=1.19, 95% CI: 0.66-2.16, P=0.563) between OS group and TS group. However, the incidence of postoperative hirschsprung-associated enterocolitis (HAEC) in the TS group was significantly lower than that of the OS group (OR=2.09, 95% CI: 1.34-3.25, P=0.001). In terms of defecation function, there were no significant differences in the rate of smooth defecation function (OR=1.08, 95% CI: 0.58-2.01, P=0.804), soiling (OR=0.60, 95% CI: 0.26-1.42, P=0.249) and fecal incontinence (OR=0.52, 95% CI: 0.17-1.55, P=0.237) between the two groups, but the incidence of constipation in the OS group was significantly lower than that of the TS group (OR=0.49, 95% CI: 0.30-0.81, P=0.006).

Conclusion

OS for HD can avoid the TS surgery associated complications, and compared with TS, the incidence of constipation is significantly lower, but the incidence of HAEC is significantly higher.

Key words: Hirschsprung disease, Colorectal surgery, Meta-analysis, One-stage surgery, Two-stage surgery
图1 文献筛选流程
表1 纳入文献的一般资料
第一作者发表年 国家/地区 病例数（例） 男女比例 根治手术平均年龄 移行段位置（例） 并发畸形（例） 随访时间 手术方式
一期 二期 一期 二期 一期 二期 一期 二期 一期 二期 一期 二期 一期 二期
Langer 1996[13] 加拿大 13 23 10:3 17:6 无 无 RS:10;DC:1;TVC:2 RS:17;DC:6 7 10 平均14个月 平均19个月 So
Skarsgard 1996[14] 加拿大 7 20 7:0 14:6 2个月 21个月 RS:7 RS:20 0 0 无 So
Pierro 1997[15] 英国 28 59 无 无 NA NA RS:28 RS:59 5 6 无 Du:25 Sw:3 Du:47 Sw:8 So:4
Santos 1999[16] 加拿大 18 47 无 无 5 d 268 d RS:14;DC:2;AC:2 RS:37;DC:8;AC:2 3 11 3~33个月 1~10个月 Sw:18 Sw:41 So:4 Du:2
Van der Zee 2000[17] 荷兰 29 27 无 无 无 无 RS:29 RS:27 0 0 5~7年 8~14年 Du
Teitelbaum 2000[18] 美国 78 103 57:21 69:34 18 d 19.6个月 RS:58;DC:7;AC:3;TC:8 RS:76 DC:6;TVC:10;TC:8 28 32 无 So
Liu 2002[19] 中国台湾 23 27 17:6 20:7 无 无 RS:17;LSA:6 RS:19;LSA:5;TC:3 无 无 2~20年 Du
Auwera 2005[20] 比利时 8 8 7:1 无 4 d 11个月 RS:8 RS:8 无 无 3个月至3年 Sw
Chiengkriwate 2007[21] 泰国 30 20 27:3 13:7 72 d 144 d RS:28;DC:1;TVC:1 RS:13;DC:6;TVC:1 无 无 12个月 16个月 Du
郑百俊2015[22] 中国 26 39 19:7 29:10 7个月 8个月 LSA:26 LSA:39 3 3 5年以上 So
图2 术后小肠结肠炎发生率
图3 术后吻合口狭窄发生率
图4 术后吻合口瘘发生率
图5 术后肠梗阻发生率
图6 术后手术部位感染发生率
图7 术后直肠脱垂发生率
图8 术后再次手术率
图9 术后便秘发生率
图10 术后大便失禁发生率
图11 术后污粪发生率
图12 术后排便功能良好率
图13 纳入文献的发表偏倚分析Egger漏斗图
图14 纳入文献的敏感性分析图
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