选择性肠造口在直肠癌低位前切除患者中作用的Meta分析

背景与目的：选择性肠造口是否能预防直肠癌低位前切除术后吻合15漏及减轻其影响各家报道不一，本研究利用Meta分析的方法探讨直肠癌低位前切除后是否需要选择性行预防性肠造口。方法：收集1990至2007年国内外公开发表的有关选择性肠造口在直肠癌低位前切除中作用的文献，将直肠癌前切除加选择性肠造口组与单纯直肠癌切除术组的吻合口漏发生率及需要再次手术的吻合口漏发生率进行综合比较。结果：符合要求的有7篇文章．7个对照临床试验研究，累计病例5040例。（1）选择性肠造口对直肠癌低位前切除术后发生吻合口漏的影响：合并OR值0．68（95％CI=0．45～1．02，P〉0．05），差异没有统计学意义；选择性肠造口未显著降低直肠癌低位前切除后吻合口漏的发生。（2）选择性肠造口对直肠癌低位前切除术后发生需要再次手术的吻合口漏的影响：合并OR值0．33（95％CI=0．25—0．44），差异有统计学意义（P〈0．001）；选择性肠造口显著降低直肠癌低位前切除后需要再次手术的吻合口漏的发生率。结论：选择性肠造口未能降低直肠癌前切除术后吻合口漏的发生率，但能降低需要再次手术的吻合口漏的发生率，对具有发生吻合口漏危险因素者应同时行选择性肠造口。

Meta-analysis of selective defunctioning stoma in low anterior resection

Background and Objective： Whether selective defunctioning stoma could reduce the rate of anastomotic leak and lessen adverse effects in low anterior resection （LAR） remains controversial. This study was to evaluate the necessity of selective defunctioning stoma after LAR. Methods. Medline databases were searched and English-language articles regarding to selective defunctioning stoma in LAR published from January 1, 1990 to October 1, 2007 were acquired. Seven literatures from seven different studies were included in this study, with total enrollment of 5040 patient. The rate of anastomotic leakage and re-operation rate in different surgical procedures （with or without selective defunctioning stoma） were pooled to compare using meta-analysis. Results. Selective defunctioning stoma did not significantly reduce the rate of anastomotic leakage after LAR. The pooled odds ratio （OR） was 0.68 （95%CI =0.45-1.02, P〉0.05）. Selective defunctioning stoma significantly reduced the rate of surgery-required anastomotic leakage following LAR. The pooled OR was 0.33（95% Cl=0.25- 0.44, P〈0.01）. Conclusion： Although selective defunctioning stoma does not reduce the rate of anastomotic leakage, it reduces the rate of surgeryrequired anastomotic leakage.