A meta-analysis of the use of a transanal drainage tube to prevent anastomotic leakage after anterior resection by double-stapling technique for rectal cancer
A meta-analysis of the use of a transanal drainage tube to prevent anastomotic leakage after anterior resection by double-stapling technique for rectal cancer
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DOI：
10.1007/s00464-015-4237-3
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发表时间：
2016-02-01
影响因子：
3.1
通讯作者：
Kitagawa, Yuko
中科院分区：
文献类型：
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作者：
Shigeta, Kohei;Okabayashi, Koji;Kitagawa, Yuko
经肛门引流管（TDT）放置降低直肠癌术后吻合口漏风险的安全性和有效性尚未得到验证。本荟萃分析的目的是评估TDT预防直肠癌前切除术后吻合口漏的有效性。PubMed和Cochrane图书馆数据库检索了比较TDT和非TDT的研究。本研究的终点定义为吻合口瘘和再手术的发生率。使用Review Manager 5.1软件对这些变量的相对影响进行综合。4项试验包括909名受试者（401例TDT病例和508例非TDT病例）符合我们的纳入标准。加权平均吻合口瘘发生率为4%[95%可信区间（CI） 1 ~ 6%]， TDT组吻合口瘘发生率明显低于非TDT组[优势比（OR） 0.30；95% ci 0.16-0.55；P = 0.0001]。此外，TDT组与非TDT组在再手术率方面存在显著差异（OR 0.18; 95% CI 0.07-0.44; p = 0.0002）。meta回归分析未发现与吻合口漏或再手术相关的显著协变量。所有研究的吻合口漏和再手术率均在95%置信区间内。通过漏斗图的目测评估，未发现明显的发表偏倚（Egger检验；吻合口漏：p = 0.056，再手术：p = 0.681）。放置TDT是一种有效和安全的方法，可以减少吻合口漏和前切除术后的再手术率。
The safety and efficacy of transanal drainage tube (TDT) placement to decrease the risk of postoperative anastomotic leakage after rectal cancer surgery has not been validated. The objective of this meta-analysis was to evaluate the usefulness of a TDT for the prevention of anastomotic leakage after an anterior resection for rectal cancer.The PubMed and Cochrane Library databases were searched for studies comparing TDT and non-TDT. The endpoint utilized in this study was defined as the rates of anastomotic leakage and re-operation. The relative effects of these variables were synthesized using Review Manager 5.1 software.Four trials including 909 participants (401 TDT cases and 508 non-TDT cases) met our inclusion criteria. The weighted mean anastomotic leakage rate was 4 % [95 % confidence interval (CI) 1-6 %], and a significantly lower risk of anastomotic leakage was identified in the TDT group compared with the non-TDT group [odds ratio (OR) 0.30; 95 % CI 0.16-0.55; p = 0.0001]. Furthermore, there were significant differences between the TDT and non-TDT groups in terms of the re-operation rate (OR 0.18; 95 % CI 0.07-0.44; p = 0.0002). No significant covariates related to anastomotic leakage or re-operation were identified in meta-regression analysis. Both the anastomotic leakage and re-operation rates for all studies lay inside the 95 % confidence interval boundaries. No visible publication bias was found by visual assessment of the funnel plot (Egger's test; anastomotic leakage: p = 0.056, re-operation: p = 0.681).Placement of a TDT is an effective and safe procedure that can decrease the rate of anastomotic leakage and re-operation after an anterior resection.