CAJ | 학술논문

目的评价术前腔内支架治疗左半结肠和直肠癌肠梗阻的安全性与有效性.方法利用CENTRAL、PubMed、EMBASE、Medline、Ovid LWW等英文数据库和CMB、CNKI、万方等中文数据库,全面检索术前腔内支架与急诊手术治疗左半结肠和直肠癌肠梗阻的比较研究的中英文随机对照试验和回顾性分析文献,利用RevMan5.1软件对两种治疗方法的安全性和有效性指标进行Meta分析.结果最终纳入14篇文献共1083例患者,其中随机对照研究5篇,回顾性分析9篇.与急诊手术相比,术前腔内支架组围手术期死亡率(RR=0.52; 95％CI:0.30～0.93,P＜0.05)和总并发症发生率降低(RR=0.46,95％CI:0.31～0.70,P＜0.01),手术切除率提高(RR=1.90,95％CI:1.33～2.70,P＜0.01),手术时间(MD=-59.77,95％CI:-87.51～-32.04,P＜0.01)和术后排气时间缩短(MD=-10.78,95％CI:- 16.67～-4.90,P＜0.01)；两种方法的永久造瘘率和住院时间的差异则无统计学意义(均P＞0.05).结论术前腔内支架治疗左半结肠和直肠癌肠梗阻的安全性和有效性均优于急诊手术.
목적 평개술전강내지가치료좌반결장화직장암장경조적안전성여유효성.방법 이용CENTRAL、PubMed、EMBASE、Medline、Ovid LWW등영문수거고화CMB、CNKI、만방등중문수거고,전면검색술전강내지가여급진수술치료좌반결장화직장암장경조적비교연구적중영문수궤대조시험화회고성분석문헌,이용RevMan5.1연건대량충치료방법적안전성화유효성지표진행Meta분석.결과 최종납입14편문헌공1083례환자,기중수궤대조연구5편,회고성분석9편.여급진수술상비,술전강내지가조위수술기사망솔(RR=0.52; 95％CI:0.30～0.93,P＜0.05)화총병발증발생솔강저(RR=0.46,95％CI:0.31～0.70,P＜0.01),수술절제솔제고(RR=1.90,95％CI:1.33～2.70,P＜0.01),수술시간(MD=-59.77,95％CI:-87.51～-32.04,P＜0.01)화술후배기시간축단(MD=-10.78,95％CI:- 16.67～-4.90,P＜0.01)；량충방법적영구조루솔화주원시간적차이칙무통계학의의(균P＞0.05).결론 술전강내지가치료좌반결장화직장암장경조적안전성화유효성균우우급진수술.
Objective To evaluate the safety and efficacy of self-expending metallic stents (SEMS) as bridge to surgery versus emergency surgery for left-sided malignant colorectal obstruction.Methods A comprehensive literature search of CENTRAL, PubMed, EMBASE, Medline, Ovid LWW,CMB,CNKI and Wanfang Databases were performed for all randomized controlled trials or retrospective studies comparing self-expending metallic stents as bridge to surgery (SABS group) with emergency surgery (ES group).A meta-analysis was carried out by RevMan5.1 software on the outcomes concerning safety and efficacy of the two groups.Results Fourteen studies matched the criteria including 1083 patients.Five were randomized controlled trials and nine were retrospective analysis.Compared with the ES group,the SABS group had a lower short-term mortality (RR=0.52,95％ CI:0.30-0.93,P＜0.05),lower overall complications (RR=0.46,95％ CI:0.31-0.70,P＜0.05),higher resection rate (RR=1.90,95％CI:1.33-2.70,P＜0.01),shorter operative time (MD=-59.77,95％CI:-87.51--32.04,P＜0.01),and shorter interval to first flatus (MD=-10.78,95％CI:-16.67--4.90,P＜0.01 ).There were no statistically significant differences between the two groups in permanent stomy and hospital stay.Conclusion The safety and efficacy of self-expending metallic stents as bridge to surgery for left-sided malignant colorectal obstruction is superior to emergency surgery.