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中华普通外科学文献(电子版) ›› 2023, Vol. 17 ›› Issue (01) : 75 -80. doi: 10.3877/cma.j.issn.1674-0793.2023.01.016

循证医学

内镜支架减压对比肠造口减压对梗阻性结直肠癌择期手术近远期疗效影响的Meta分析
严正蓉1, 柏丹1, 覃相志1, 周冬兵1, 任明扬1, 李权林1,()   
  1. 1. 637000 南充,川北医学院附属南充市中心医院胃肠外科
  • 收稿日期:2022-08-18 出版日期:2023-02-01
  • 通信作者: 李权林
  • 基金资助:
    四川省医学青年创新科研课题计划(S21082)

Endoscopic stent decompression versus stoma decompression on short- and long-term efficacy as a bridge to elective resection for obstructive colorectal cancer: A meta-analysis

Zhengrong Yan1, Dan Bai1, Xiangzhi Qin1, Dongbing Zhou1, Mingyang Ren1, Quanlin Li1,()   

  1. 1. Department of Gastrointestinal-Colorectal Surgery, Nanchong Central Hospital Affiliated to North Sichuan Medical College, Nanchong 637000, China
  • Received:2022-08-18 Published:2023-02-01
  • Corresponding author: Quanlin Li
引用本文:

严正蓉, 柏丹, 覃相志, 周冬兵, 任明扬, 李权林. 内镜支架减压对比肠造口减压对梗阻性结直肠癌择期手术近远期疗效影响的Meta分析[J/OL]. 中华普通外科学文献(电子版), 2023, 17(01): 75-80.

Zhengrong Yan, Dan Bai, Xiangzhi Qin, Dongbing Zhou, Mingyang Ren, Quanlin Li. Endoscopic stent decompression versus stoma decompression on short- and long-term efficacy as a bridge to elective resection for obstructive colorectal cancer: A meta-analysis[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(01): 75-80.

目的

比较急诊造口减压和内镜支架减压后择期手术切除治疗梗阻性结直肠癌的近远期效果。

方法

检索PubMed、Embase、Cochrane Library、中国知网、万方数据库已公开发表的有关造口减压对比内镜支架减压后序贯择期手术切除的梗阻性结直肠癌近远期效果的文献,提取的数据采用RevMan 5.3软件进行Meta分析。

结果

共10篇回顾性病例对照研究纳入汇总分析,Newcastle-Ottawa Scale评分范围为6~8分,其中高质量文献6篇。总样本量为1 807例,包括造口组939例,支架组868例。汇总分析结果提示,支架组两次手术间隔时间短于造口组(WMD=13.37,95% CI:7.88~18.86,P<0.000 01),但造口组择期手术一期吻合率高于支架组(OR=1.58,95% CI:1.10~2.26,P=0.01),3年总生存率也高于支架组(HR=0.77,95% CI:0.61~0.97,P=0.02)。两组在择期手术入路方式、永久性造口率、总体并发症和围手术期死亡率方面比较,差异均无统计学意义。

结论

肠造口减压和内镜支架减压对梗阻性结直肠癌患者后续择期行结直肠癌根治术的安全性相近,但是肠造口减压患者的总生存率更高,远期疗效方面更胜一筹。

Objective

To compare the short-and long-term efficacy after endoscopic stent versus stoma decompression as a bridge to elective resection for obstructive colorectal cancer.

Methods

The databases such as PubMed, Embase, Cochrane Library, CNKI, WanFang data were searched to retrieve literature comparing stoma decompression with endoscopic stent as a bridge to surgery for obstructive colorectal cancer. Data were extracted and analyzed using RevMan 5.3 statistical software.

Results

Ten retrospective case-control studies were finally retrieved, with 6-8 points by the Newcastle-Ottawa Scale, 6 of which were high-quality literatures. A total of 1 807 cases were included in the study, 939 of whom were divided into stoma group and 868 were stent group. Compared to the stoma group, the stent group was associated with significantly shorter time interval between decompression surgery and elective resection for obstructive colorectal cancer (WMD=13.37, 95% CI: 7.88-18.86, P<0.000 01). However, the stoma group showed better primary anastomotsis (OR=1.58, 95% CI: 1.10-2.26, P=0.01) and 3-year overall survival than the stent group (HR=0.77, 95% CI: 0.61-0.97, P=0.02). No significant differences were found in terms of surgical approach, permanent stoma, overall complication and perioperative mortality between the two groups.

Conclusions

The stoma decompression as a bridge to surgery provides similar safety with endoscopic stent for patients with obstructive colorectal cancer undergoing subsequent elective radical resection. However, stoma decompression has advantages of long-term efficacy, providing higher overall survival.

图1 文献筛选流程图
表1 纳入各文献的基本临床资料
表2 纳入原始文献的NOS量表质量评价结果(分)
图2 两组患者两次手术间隔时间的Meta分析森林图
图3 两组患者择期手术入路方式的Meta分析森林图
图4 两组患者择期手术一期吻合率的Meta分析森林图
图5 两组患者择期手术后永久性造口率的Meta分析森林图
图6 两组患者择期手术后总体并发症的Meta分析森林图
图7 两组患者择期手术围手术期死亡率的Meta分析森林图
图8 两组患者3年总体生存率的Meta分析森林图
图9 两组患者3年无瘤生率的Meta分析森林图
图10 以术后总体并发症为指标的漏斗图
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