一期手术与二期手术治疗先天性巨结肠的Meta分析

目的比较一期手术和二期手术治疗先天性巨结肠（HD）的术后并发症及排便功能。 方法通过检索Pubmed、Web of Science、中国知网、万方中文数据库，筛选出2018年6月之前发表的符合标准的一期手术与二期手术治疗HD的对比研究。应用STATA 14.0软件对纳入文献的相关数据进行Meta分析，同时对纳入文献进行发表偏倚检验及敏感性分析。 结果共筛选出10篇文献633例患者，包括9篇英文和1篇中文回顾性对比研究。Meta分析结果显示：在术后并发症方面，一期手术组与二期手术组在吻合口狭窄（OR=0.56，95% CI：0.29~1.09，P=0.087）、吻合口瘘（OR=1.01，95% CI：0.16~6.51，P=0.995）、肠梗阻（OR=0.88，95% CI：0.44~1.75，P=0.708）、直肠脱垂（OR=1.29，95% CI：0.35~4.82，P=0.705）、手术部位感染（OR=0.61，95% CI：0.31~1.20，P=0.152）、再次手术（OR=1.19，95% CI：0.66~2.16，P=0.563）的发生率比较，差异均无统计学意义，而二期手术组的术后小肠结肠炎（HAEC）发生率明显低于一期手术组（OR=2.09，95% CI：1.34~3.25，P=0.001）。在排便功能方面，两组术后排便功能良好率（OR=1.08，95% CI：0.58~2.01，P=0.804）、污粪（OR=0.60，95% CI：0.26~1.42，P=0.249）和大便失禁（OR=0.52，95% CI：0.17~1.55，P=0.237）的发生率比较，差异均无统计学意义，但一期手术组术后便秘发生率显著低于二期手术组（OR=0.49，95% CI：0.30~0.81，P=0.006）。 结论一期手术治疗HD避免了二期手术相关的吻合口并发症，而且便秘的发生率明显低于二期手术，但是HAEC发生率明显高于二期手术。

One-stage versus two-stage surgery for the treatment of Hirschsprung’s disease: A Meta-analysis

ObjectiveTo compare the postoperative complications and defecation function in patients with Hirschsprung’s disease (HD) treated with one-stage surgery (OS) and two-stage surgery (TS). MethodsBy searching Pubmed, Web of Science, CNKI, Wanfang databases, a comparative study of OS and TS surgical treatment of HD published before June 2018 was screened out. The relevant data in the included literature, publication bias and sensitivity were analyzed using STATA 14.0 software. ResultsTen articles including 633 cases, nine English studies and one Chinese retrospective comparative study were retrieved. In terms of postoperative complications, there were no significant differences in the incidence of anastomotic stricture (OR=0.56, 95% CI: 0.29-1.09, P=0.087), anastomotic fistula (OR=1.01,95% CI: 0.16-6.51, P=0.995), intestinal obstruction (OR=0.88, 95% CI: 0.44-1.75, P=0.708), rectal prolapse (OR=1.29, 95% CI: 0.35-4.82, P=0.705), surgical site infection (OR=0.61, 95% CI: 0.31-1.20,P=0.152) and reoperation (OR=1.19, 95% CI: 0.66-2.16, P=0.563) between OS group and TS group. However, the incidence of postoperative hirschsprung-associated enterocolitis (HAEC) in the TS group was significantly lower than that of the OS group (OR=2.09, 95% CI: 1.34-3.25, P=0.001). In terms of defecation function, there were no significant differences in the rate of smooth defecation function (OR=1.08, 95% CI: 0.58-2.01, P=0.804), soiling (OR=0.60, 95% CI: 0.26-1.42, P=0.249) and fecal incontinence (OR=0.52, 95% CI: 0.17-1.55, P=0.237) between the two groups, but the incidence of constipation in the OS group was significantly lower than that of the TS group (OR=0.49, 95% CI: 0.30-0.81, P=0.006). ConclusionOS for HD can avoid the TS surgery associated complications, and compared with TS, the incidence of constipation is significantly lower, but the incidence of HAEC is significantly higher.