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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口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。
BACKGROUND & OBJECTIVE: Whether selective enterostomy can prevent anastomotic leakage and reduce its influence after low anterior resection of rectal cancer has been reported in different countries. In this study, Meta-analysis was used to investigate the need for selectivity after low-level resection of rectal cancer Preventive bowel stoma. Methods: The literature published from 1990 to 2007 on the role of selective enterostomy in the anterior resection of rectal cancer was collected at home and abroad. The anastomosis of anterior resection combined with selective enterostomy and resection of rectal cancer The incidence of oral leakage and the need for reoperation anastomotic leakage incidence of a comprehensive comparison. Results: In line with the requirements of seven articles, seven controlled clinical trials, a total of 5040 cases. (1) The effect of selective enterostomy on anastomotic leakage after low anterior resection of rectal cancer: the combined OR was 0.68 (95% CI = 0.45-1.02, P> 0.05), the difference was not statistically significant; Ostomy did not significantly reduce the occurrence of anastomotic leakage after anterior resection of low rectal cancer. (2) The effect of selective enterostomy on anastomotic leakage requiring reoperation after anterior resection of rectal cancer: The combined OR was 0.33 (95% CI = 0.25-0.44), the difference was statistically significant (P <0.001 ). Selective enterostomy significantly reduced the incidence of anastomotic leakage requiring reoperation after anterior resection of low rectal cancer. CONCLUSION: Selective enterostomy failed to reduce the incidence of anastomotic leakage after rectal cancer surgery, but could reduce the incidence of anastomotic leakage requiring reoperation and should be simultaneously selected for risk factors for anastomotic leakage Intestinal stoma.