中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2014年
7期
539-544
,共6页
邹科见%周卫平%李仁峰%蔡国豪
鄒科見%週衛平%李仁峰%蔡國豪
추과견%주위평%리인봉%채국호
直肠肿瘤%腹腔镜检查%吻合口漏%危险因素%Meta分析
直腸腫瘤%腹腔鏡檢查%吻閤口漏%危險因素%Meta分析
직장종류%복강경검사%문합구루%위험인소%Meta분석
Rectal neoplasms%Laparoscopy%Anastomotic leakage%Risk factors%Meta analysis
目的 系统分析影响腹腔镜直肠癌前切除术后吻合口漏发生的危险因素.方法 对2003年8月至2013年8月国内外公开发表的有关腹腔镜直肠癌前切除术后吻合口漏发生危险因素的文献进行Meta分析.数据采用优势比(OR)和95％可信区间(95％ CI)表示,采用x2检验和I2对异质性进行分析,采用固定或随机效应模型合并数据.结果 共纳入文献8篇,包括3 289例直肠癌患者,吻合口漏的发生率为6.050％(199/3 289).男性腹腔镜直肠癌前切除术患者术后吻合口漏发生风险高于女性(OR =2.17,95％ CI:1.54 ～ 3.06,P＜0.05);新辅助化疗亦可能增加术后吻合口漏发生风险(OR=1.53,95％ CI:1.00～2.32,P＜0.05);围手术期输血可能增加术后吻合口漏发生风险(OR=4.80,95％ CI:2.98 ～7.73,P＜0.05);低位直肠癌较高位直肠癌术后吻合口漏发生风险高(OR=1.60,95％CI:1.14～2.23,P＜0.05);切割闭合器钉匣数目≥3个增加术后吻合口漏发生风险(OR =0.46,95％CI:0.27 ～0.78,P＜0.05).而ASA分级、肿瘤浸润深度、淋巴结转移、预防性肠造口与术后吻合口瘘发生风险无关(OR=0.66,0.91,1.25,0.78,95％CI:0.36～1.20,0.55～1.51,0.75 ～2.09,0.50 ～1.23,P＞0.05).结论 男性、新辅助化疗、围手术期输血、低位直肠癌、切割闭合器钉匣数目≥3个是腹腔镜直肠癌前切除术后吻合口漏发生的主要危险因素.
目的 繫統分析影響腹腔鏡直腸癌前切除術後吻閤口漏髮生的危險因素.方法 對2003年8月至2013年8月國內外公開髮錶的有關腹腔鏡直腸癌前切除術後吻閤口漏髮生危險因素的文獻進行Meta分析.數據採用優勢比(OR)和95％可信區間(95％ CI)錶示,採用x2檢驗和I2對異質性進行分析,採用固定或隨機效應模型閤併數據.結果 共納入文獻8篇,包括3 289例直腸癌患者,吻閤口漏的髮生率為6.050％(199/3 289).男性腹腔鏡直腸癌前切除術患者術後吻閤口漏髮生風險高于女性(OR =2.17,95％ CI:1.54 ～ 3.06,P＜0.05);新輔助化療亦可能增加術後吻閤口漏髮生風險(OR=1.53,95％ CI:1.00～2.32,P＜0.05);圍手術期輸血可能增加術後吻閤口漏髮生風險(OR=4.80,95％ CI:2.98 ～7.73,P＜0.05);低位直腸癌較高位直腸癌術後吻閤口漏髮生風險高(OR=1.60,95％CI:1.14～2.23,P＜0.05);切割閉閤器釘匣數目≥3箇增加術後吻閤口漏髮生風險(OR =0.46,95％CI:0.27 ～0.78,P＜0.05).而ASA分級、腫瘤浸潤深度、淋巴結轉移、預防性腸造口與術後吻閤口瘺髮生風險無關(OR=0.66,0.91,1.25,0.78,95％CI:0.36～1.20,0.55～1.51,0.75 ～2.09,0.50 ～1.23,P＞0.05).結論 男性、新輔助化療、圍手術期輸血、低位直腸癌、切割閉閤器釘匣數目≥3箇是腹腔鏡直腸癌前切除術後吻閤口漏髮生的主要危險因素.
목적 계통분석영향복강경직장암전절제술후문합구루발생적위험인소.방법 대2003년8월지2013년8월국내외공개발표적유관복강경직장암전절제술후문합구루발생위험인소적문헌진행Meta분석.수거채용우세비(OR)화95％가신구간(95％ CI)표시,채용x2검험화I2대이질성진행분석,채용고정혹수궤효응모형합병수거.결과 공납입문헌8편,포괄3 289례직장암환자,문합구루적발생솔위6.050％(199/3 289).남성복강경직장암전절제술환자술후문합구루발생풍험고우녀성(OR =2.17,95％ CI:1.54 ～ 3.06,P＜0.05);신보조화료역가능증가술후문합구루발생풍험(OR=1.53,95％ CI:1.00～2.32,P＜0.05);위수술기수혈가능증가술후문합구루발생풍험(OR=4.80,95％ CI:2.98 ～7.73,P＜0.05);저위직장암교고위직장암술후문합구루발생풍험고(OR=1.60,95％CI:1.14～2.23,P＜0.05);절할폐합기정갑수목≥3개증가술후문합구루발생풍험(OR =0.46,95％CI:0.27 ～0.78,P＜0.05).이ASA분급、종류침윤심도、림파결전이、예방성장조구여술후문합구루발생풍험무관(OR=0.66,0.91,1.25,0.78,95％CI:0.36～1.20,0.55～1.51,0.75 ～2.09,0.50 ～1.23,P＞0.05).결론 남성、신보조화료、위수술기수혈、저위직장암、절할폐합기정갑수목≥3개시복강경직장암전절제술후문합구루발생적주요위험인소.
Objective To investigate the risk factors of anastomotic leakage after laparoscopic anterior resection of rectal cancer.Methods Literatures on the risk factors of laparoscopic anterior resection of rectal cancer were retrieved from August 2003 to August 2013,and then a Meta analysis was carried out based on the data.Data were expressed by odds ratio (OR) and 95％ confidence interval (95％ CI).The heterogeneity of the data was analyzed using the chi-square test or I2 test.Data were pooled using the fixed or random model.Results Eight literatures including 3 289 patients with rectal cancer were retrieved.The incidence of anastomotic leakage was 6.050％ (199/3 289).The incidence of anastomotic leakage after laparoscopic anterior resection of rectal cancer in males was significantly higher than females (OR =2.17,95％ CI:1.54-3.06,P ＜0.05).Neo-adjuvant chemotherapy might increase the risk of postoperative anastomotic leakage (OR =1.53,95％ CI:1.00-2.32,P ＜ 0.05).Interoperative blood transfusion might increase the risk of postoperative anastomotic leakage (OR =4.80,95％CI:2.98-7.73,P ＜0.05).Patients with low rectal cancer had greater risk of anastomotic leakage than those with high rectal cancer (OR =1.60,95％ CI:1.14-2.23,P ＜ 0.05).Number of linear stapler firings greater than 3 increased the risk of postoperative anastomotic leakage (OR =0.46,95％ CI:0.27-0.78,P ＜ 0.05).The ASA classification of anethesia risk,depth of tumor infiltration,lymph node metastasis,preventive colostomy were not correlated with the incidence of postoperative anastomotic leakage (OR =0.66,0.91,1.25,0.78,95％CI:0.36-1.20,0.55-1.51,0.75-2.09,0.50-1.23,P＞0.05).Conclusion Male,neo-adjuvant chemotherapy,interoperative blood transfusion,low rectal cancer,number of linear stapler firings greater than 3 are the main risk factors for anastomotic leakage after laparoscopic anterior resection of rectal cancer.
