CAJ | 학술논문

目的探讨吻合口在腹膜反折以下的直肠癌低位前切除术中预防性肠造瘘的必要性.方法检索Medline、Embase、Cochrane Library、万方和中国知网(CNKI)数据库,对符合纳入标准的文章进行Meta分析.结果 6篇随机对照研究(包括648例低位直肠癌患者,其中预防性造瘘组332例,未造瘘组316例)和25篇回顾性对照研究(包括10 722例低位直肠癌患者,其中预防性造瘘组4470例,未造瘘组6252例)纳入研究分析.综合分析显示,与未造瘘组比较,预防性肠造瘘能够降低术后吻合口瘘发生率(随机对照研究RR=0.33,95％ CI:0.21～0.53；回顾性对照研究OR=0.60,95％ CI:0.42～0.85)、吻合口瘘再手术率(随机对照研究RR=0.30,95％ CI:0.16～0.53;回顾性对照研究OR=0.26;95％ CI:0.21～0.32)及吻合口瘘相关死亡率(回顾性对照研究OR=0.41；95％CI:0.27～0.62)(均P＜0.05).结论对于具有术后吻合口瘘高危因素的直肠癌患者,行低位前切除术中应常规行预防性造瘘.
목적 탐토문합구재복막반절이하적직장암저위전절제술중예방성장조루적필요성.방법 검색Medline、Embase、Cochrane Library、만방화중국지망(CNKI)수거고,대부합납입표준적문장진행Meta분석.결과 6편수궤대조연구(포괄648례저위직장암환자,기중예방성조루조332례,미조루조316례)화25편회고성대조연구(포괄10 722례저위직장암환자,기중예방성조루조4470례,미조루조6252례)납입연구분석.종합분석현시,여미조루조비교,예방성장조루능구강저술후문합구루발생솔(수궤대조연구RR=0.33,95％ CI:0.21～0.53；회고성대조연구OR=0.60,95％ CI:0.42～0.85)、문합구루재수술솔(수궤대조연구RR=0.30,95％ CI:0.16～0.53;회고성대조연구OR=0.26;95％ CI:0.21～0.32)급문합구루상관사망솔(회고성대조연구OR=0.41；95％CI:0.27～0.62)(균P＜0.05).결론 대우구유술후문합구루고위인소적직장암환자,행저위전절제술중응상규행예방성조루.
Objective To evaluate the necessity of defunetioning stoma in low anternor resection for rectal cancer below peritoneal reflection.Methods The databases of Medline,Embase,Cochrane Library,Wangfang and CNKI were searched.The eligible studies were identified for pooled analyses.Results Six randomized controlled trials with 648 cases(332 patients with defunctioning stoma and 316 without stoma) and 25 retrospective controlled trials with 10,722 cases (4,470 patients with defunctioning stoma and 6,252 without stoma) were included. Combined analyses showed that defunctioning stoma was effective for decreasing risk of postoperative anastomotic leakage (RR=0.33 and 95％ CI:0.21-0.53 for RCTs,OR=0.60 and 95％ CI:0.42-0.85 for retrospective studies),reoperation (RR=0.30,95％ CI:0.16-0.53 for RCTs,OR=0.26 and 95％ CI:0.21-0.32 for retrospective studies) and mortality (OR=0.41,95％ CI:0.27-0.62 for retrospective studies).Conclusion Defunctioning stoma should be routinely performed in low anterior resection for high-risk patients.