Colonic stenting vs emergent surgery for acute left-sided malignant colonic obstruction: A systematic review and meta-analysis
Colonic stenting vs emergent surgery for acute left-sided malignant colonic obstruction: A systematic review and meta-analysis
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DOI：
10.3748/wjg.v18.i39.5608
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发表时间：
2012-10-21
影响因子：
4.3
通讯作者：
Zhong, Ming
中科院分区：
文献类型：
--
作者：
Ye, Guang-Yao;Cui, Zhe;Zhong, Ming
目的：目的：探讨急诊术前自膨式金属支架（SEMS）与急诊手术治疗急性左半结肠恶性梗阻的疗效。方法：两名研究者独立检索MEDLINE、EMBASE和科克伦对照试验中心，以及纳入研究的参考文献，以确定比较两种或两种以上手术方式治疗急性结肠梗阻的随机对照试验（RCT）。结果：8项研究符合入选标准，共444例患者，其中219例接受SEMS，225例接受急诊手术。7篇研究报道了两组间一期造口率的差异（RR，0.60; 95% CI：0.48-0.76; P < 0.0001）。只有3项RCT描述了随访造口率，两组之间无显著差异（RR，0.80; 95%CI：0.59-1.08; P = 0.14）。两组死亡率差异无统计学意义（RR，0.91; 95% CI：0.50-1.66; P = 0.77），但总发病率差异有统计学意义（RR，0.57; 95% CI：0.44-0.74; P < 0.0001）。两组吻合口瘘发生率无显著差异（RR，0.60; 95%CI：0.28-1.28; P = 0.19），发生脓肿，包括造口周围脓肿、腹腔脓肿和壁脓肿（RR，0.83; 95% CI：0.36-1.95; P = 0.68），以及其他腹部并发症（RR：0.67; 95%CI：0.40-1.12; P = 0.13）。对于急性左半结肠恶性梗阻患者，SEMS并不明显优于急诊手术。(C)2012年百世登。All rights reserved.
AIM: To investigate the effects of emergent preoperative self-expandable metallic stent (SEMS) vs emergent surgery for acute left-sided malignant colonic obstruction.METHODS: Two investigators independently searched the MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials, as well as references of included studies to identify randomized controlled trials (RCTs) that compared two or more surgical approaches for acute colonic obstruction. Summary risk ratios (RR) and 95% CI for colonic stenting and emergent surgery were calculated.RESULTS: Eight studies met the selection criteria, involving 444 patients, of whom 219 underwent SEMS and 225 underwent emergent surgery. Seven studies reported difference of the one-stage stoma rates between the two groups (RR, 0.60; 95% CI: 0.48-0.76; P < 0.0001). Only three RCTs described the follow-up stoma rates, which showed no significant difference between the two groups (RR, 0.80; 95% CI: 0.59-1.08; P = 0.14). Difference was not significant in the mortality between the two groups (RR, 0.91; 95% CI: 0.50-1.66; P = 0.77), but there was significant difference (RR, 0.57; 95% CI: 0.44-0.74; P < 0.0001) in the overall morbidity. There were no significant differences between the two groups in the anastomotic leak rate (RR, 0.60; 95% CI: 0.28-1.28; P = 0.19), occurrence of abscesses, including peristomal abscess, intraperitoneal abscess and parietal abscess (RR, 0.83; 95% CI: 0.36-1.95; P = 0.68), and other abdominal complications (RR: 0.67; 95% CI: 0.40-1.12; P = 0.13).CONCLUSION: SEMS is not obviously more advantageous than emergent surgery for patients with acute left-sided malignant colonic obstruction. (C) 2012 Baishideng. All rights reserved.