国内结肠造口术和回肠袢式造口术对老年乙状结肠癌、直肠癌的临床疗效的Meta分析

目的应用Meta分析方法系统评价国内结肠造口术和回肠袢式造口术对老年乙状结肠癌、直肠癌的疗效及安全性。 方法计算机检索中国知网、万方数据知识服务平台、维普期刊资源整合服务平台、中国生物医学文献数据库，收集老年乙状结肠癌、直肠癌患者进行一期切除肿瘤并肠造口，二期对肠造口行闭合术的文献。检索时限均为从建库至2017年4月。制定纳入以及排除标准，查找相关文献，评价偏倚风险，最终提取纳入的文献的数据，使用RevMan 5.3软件进行Meta分析。 结果本项研究共有13篇文献，926例患者进行一期肿瘤切除并肠造口，二期对肠造口行闭合术入选，通过Meta分析结果显示，回肠袢式造口组一期术后排气时间（MD=-1.87，95%CI：-2.20~-1.54，P<0.001）、一期术后禁食时间（MD=-2.11，95%CI：-2.28~-1.94，P<0.001）、一期术后住院时间（MD=-0.53，95%CI：-0.97~-0.10，P=0.02）、一期术后并发症发生率（OR=0.55，95%CI：0.32~0.97，P=0.04）、二期手术时间（MD=-1.04，95%CI：-1.22~-0.86；P<0.001）、二期术后排气时间（MD=-1.67，95%CI：-1.89~-1.45；P<0.001）、二期术后禁食时间（MD=-1.67，95%CI：-1.90~-1.44；P<0.001）、二期术后住院时间（MD=-2.19，95%CI：-2.58~-1.79；P<0.001）、二期术后并发症发生率（OR=0.19，95%CI：0.11~0.33；P<0.001）与结肠造口组相比，差异有统计学意义，一期手术时间（MD=0.04，95%CI：-0.03~0.11；P=0.25）差异无统计学意义。 结论回肠袢式造口组在住院时间、肠胃功能恢复时间、二期手术时间、术后并发症发生率几个方面要优于结肠造口组。

Clinical efficacy of leal loop colostomy surgery vs colostomy in sigmoid colon cancer and rectal cancer: A Meta-analysis

ObjectiveThe meta-analysis method was used to systematically evaluate the efficacy and safety of domestic colostomy and ileostomy for elderly patients with sigmoid colon cancer and rectal cancer. MethodsUse computer to search China Knowledge Network, Wanfang Data Knowledge Service Platform, Weipu Journal Resource Integration Service Platform, China Biomedical Literature Database, collect patients with sigmoid colon cancer and rectal cancer for stageⅠresection and intestinal stoma, stage Ⅱ for intestinal Literature for oral closure. The search time limit is from the establishment of the library to April 2017. Inclusion and exclusion criteria were developed, relevant literature was searched, risk of bias was assessed, data from the included literature was finally extracted, and Meta analysis was performed using RevMan 5.3 software. ResultsThere were 13 articles in this study, 926 patients underwent stage Ⅰ tumor resection and enterostomy, and stageⅡclosed for enterostomy. The meta-analysis showed that the ileal fistula group was discharged after the first stage. Time (MD=-1.87, 95%CI: -2.20~-1.54, P<0.00001), postoperative fasting time (MD=-2.11, 95%CI: -2.28~-1.94, P<0.00001), one postoperative hospital stay (MD=-0.53, 95%CI: -0.97~-0.10, P=0.02), postoperative complication rate (OR=0.55, 95%CI: 0.32~0.97, P=0.04), second-stage operation time (MD=-1.04, 95%CI: -1.22~-0.86; P<0.00001), second-stage postoperative exhaust time (MD=-1.67, 95%CI: -1.89~-1.45; P<0.00001), postoperative fasting time (MD=-1.67, 95%CI: -1.90~-1.44; P<0.00001), postoperative hospital stay (MD=-2.19, 95%CI: -2.58~-1.79; P<0.00001), the second-stage postoperative complication rate (OR=0.19, 95%CI: 0.11~0.33; P<0.00001) was significantly different from the colostomy group. The time of operation (MD=0.04, 95%CI: -0.03~0.11; P=0.25) was not statistically significant. ConclusionIleal loop colostomy surgery is better than colostomy in terms of operation time, recovery time of gastrointestinal function , complication rate and hospital stay.