Meta-analysis of observational studies of ileorectal versus ileal pouch-anal anastomosis for familial adenomatous polyposis
Meta-analysis of observational studies of ileorectal versus ileal pouch-anal anastomosis for familial adenomatous polyposis
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DOI：
10.1002/bjs.5276
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发表时间：
2006-04-01
影响因子：
9.6
通讯作者：
Tekkis, PP
中科院分区：
文献类型：
--
作者：
Aziz, O;Athanasiou, T;Tekkis, PP
背景：家族性腺瘤性息肉病（FAP）的手术治疗旨在降低癌症风险，同时提供良好的功能预后。结肠切除术联合回直肠吻合术和直结肠切除术联合回肠袋-肛门吻合术都可以提供这种方法，但对于哪一种方法更好还没有明确的共识。方法：这是对1991年至2003年间发表的关于术后早期和晚期不良事件、功能结局和生活质量的比较研究的荟萃分析。结果：12项研究共1002例，其中53.4%为回肠袋，46.6%为回肠吻合。排便频率(加权平均差1.62（95%置信区间（ci .））1.05至2.20))，夜间排便（比值比（OR） 6.64(95%比值比2.99至14.74)）和使用失禁垫（OR 2.72(95%比值比1.02至7.23)）在回直肠组显著减少，尽管回肠袋减少了大便急迫性（比值比0.43(95%比值比0.23至0.80)）。回肠造袋术后30天内再手术更为常见（23.4%比11.6%;OR 2.11(95%比1.21比3.70)）。两种方法在性功能障碍、饮食限制或术后并发症方面没有显著差异。只有回肠组（5.5%）被诊断为直肠癌。结论：回肠袋吻合术与回肠直肠吻合术各有优点。需要进一步的研究来确定哪些对FAP患者最有利。
Background: Surgery for familial adenomatous polyposis (FAP) aims to minimize cancer risk while providing good functional outcome. Colectomy with ileorectal anastomosis and proctocolectomy with ileal pouch-anal anastomosis both offer this, but there is no clear consensus about which is better.Methods: This is a meta-analysis of comparative studies published between 1991 and 2003 reporting early and late postoperative adverse events, functional outcomes and quality of life.Results: Twelve studies containing 1002 patients (53.4 per cent ileal pouch, 46.6 per cent ileorectal anastomosis) were identified. Bowel frequency (weighted mean difference 1.62 (95 per cent confidence interval (c.i.) 1.05 to 2.20)), night defaecation (odds ratio (OR) 6.64 (95 per cent c.i. 2.99 to 14.74)) and use of incontinence pads (OR 2.72 (95 per cent c.i. 1.02 to 7.23)) were significantly less in the ileorectal group, although faecal urgency was reduced with the ileal pouch (odds ratio 0.43 (95 per cent c.i. 0.23 to 0.80)). Reoperation within 30 days was more common after ileal pouch construction (23.4 versus 11.6 per cent; OR 2.11 (95 per cent c.i. 1.21 to 3.70)). There was no significant difference between the techniques in terms of sexual dysfunction, dietary restriction, or postoperative complications. Rectal cancer was a diagnosis only in the ileorectal group (5.5 per cent).Conclusion: Ileal pouch and ileorectal anastomoses have individual merits. Further research is needed to determine which most benefits patients with FAP.