Handsewn vs. stapled anastomoses in colon and rectal surgery -: A meta-analysis
Handsewn vs. stapled anastomoses in colon and rectal surgery -: A meta-analysis
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DOI：
10.1007/bf02238246
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发表时间：
1998-02-01
影响因子：
3.9
通讯作者：
McLeod, RS
中科院分区：
文献类型：
--
作者：
MacRae, HM;McLeod, RS
目的：在结肠和直肠手术中比较手工缝合和缝合吻合术的试验没有发现统计学差异。尽管如此，关于哪种技术更优越，作者们的结论是不同的。为了帮助确定患者预后是否存在差异，对所有试验进行了荟萃分析。方法：采用固定效应模型对所有评价手工缝合和吻合术的随机对照试验进行荟萃分析。结果变量包括死亡率、技术问题、渗漏率、伤口感染、狭窄和癌症复发。对所有涉及结肠的吻合术和大肠吻合术的子集的结果进行了评估。结果：13个不同的试验符合纳入标准。在所有吻合术(P<；0.0001)和结直肠吻合术(P<；0.001)中，使用吻合器比手工缝合更容易出现技术问题。吻合术后狭窄也更为常见(所有吻合术P=0.015；结直肠吻合术P=0.028)。所有其他结果指标，包括死亡率、临床和放射学指标、复发率和局部癌症复发率在两组之间没有差异。结论：虽然吻合术中技术问题和术后狭窄更常见，但其他结果指标在两组之间没有差异。因此，这两种方法都是有效的，选择可能基于个人偏好。
PURPOSE: Trials comparing handsewn with stapled anastomoses in colon and rectal surgery have not found statistical differences. Despite this, authors have differed in their conclusions as to which technique is superior. To help determine whether differences in patient outcomes are present, a meta-analysis of all trials was performed. METHOD: A meta-analysis of all randomized, controlled trials assessing handsewn and stapled colon and rectal anastomoses was done using a fixed-effects model. Outcome variables were mortality, technical problems, leak rates, wound infections, strictures, and cancer recurrence. Outcomes were assessed for all anastomoses involving the colon and for the subset of colorectal anastomoses. RESULTS: Thirteen distinct trials met the inclusion criteria. Intraoperative technical problems were more likely to occur with stapled than with handsewn anastomoses for all anastomoses (P < 0.0001) and for colorectal anastomoses (P < 0.001). Strictures were also more common following stapled anastomoses (P = 0.015 for all anastomoses; P = 0.028 for colorectal anastomoses). All other outcome measures, including mortality, clinical and radiologic leaf; rates, and local cancer recurrence rates showed no difference between groups. CONCLUSION: Although intraoperative technical problems and postoperative strictures were more common with stapled anastomoses, other outcome measures showed no difference between groups. Thus, both techniques are effective, and the choice may be based on personal preference.