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术中直肠冲洗对直肠癌局部复发影响的Meta分析
365bet娱乐官网网址 作者:王君辅  谢勇  李红浪 
单位:南昌大学第二附属医院胃肠外科  江西 南昌 330006 
关键词:直肠肿瘤 直肠冲洗 复发 综合分析 手术后并发症 
DOI:R735.3+7
出版年,卷(期):页码:2013,28(5):492-498
摘要:
目的 探讨术中直肠冲洗对直肠癌术后局部复发率的影响。方法 采用Meta分析的方法对国内外已发表的9篇随机对照研究的文献进行定量综合,以直肠癌根治术中行直肠冲洗治疗的患者为冲洗组,以仅施行直肠根治术未行直肠冲洗的患者为对照组(未冲洗组),比较2组术后局部复发率,计算其风险比(RR)及95%可信区间(CI)。结果 9篇文献符合纳入标准,共有5 451例患者参与,其中4 153例接受直肠冲洗,1 298例未接受直肠冲洗。文献纳入研究显示,9项研究评估了直肠冲洗对直肠癌术后复发的影响:总复发率为7.1%(387/5 451),冲洗组直肠癌局部复发率为5.9%(245/4 153),低于未冲洗组的10.9%(142/1 298),差异有统计学意义(RR=0.55,95%CI:0.45~0.69,P<0.01);其中5项研究评估了直肠冲洗可显着降低吻合口复发的风险:冲洗组局部复发率为5.8%低于未冲洗组局部复发率10.1%,差异有统计学意义(RR=0.57,95%CI=0.46~0.71,P<0.00001)。术中直肠冲洗对显着降低吻合口复发率无影响(RR=0.3,95%CI=0.12~0.71,P=0.007)。亚组分析:采用TME术中直肠冲洗对直肠癌术后局部复发的影响,总的复发率6.7%,冲洗组复发率5.8%(230/3 971),低于未冲洗组的复发率10.1%(114/1 127),合并RR值为0.53(95%CI:0.41~0.67),差异有统计学意义(P<0.01)。结论 此Meta分析可能合理,建议术中直肠冲洗,并可能降低直肠癌术后局部复发率及吻合口复发。
Objective To explore the effect of intraoperative rectal washout on local recurrence after rectal cancer surgery.Methods The Meta-analysis was applied to analyze 9 randomized controlled quantitive studies published at home and abroad.The patients treated by rectal washout on radical resection of rectal carcinoma, and those treated only by radical resection of rectal carcinoma without rectal washout were enrolled.The local recurrence rate between the two groups was compared, and risk ratio (RR)along with 95 % confidence intervals (CI)was studied.Results Nine studies met the inclusion criteria, including a total of 5 451 patients, of whom 4 135 patients underwent rectal washout and 1 298 patients did not have rectal washout.Literature included in the study showed that nine studies contributed to this Meta analysis investigating the effect of rectal washout for local recurrence with an overall local recurrence rate of 7.1 % (387/5 451).The rate of local recurrence in the washout group was significantly lower than that in the no washout group [5.9% (245/4 153)vs 10.9% (142/1 298); RR=0.55, 95%CI:0.45~0.69,P < 0.01)].Five of the studies showed that rectal washout reduced the risk of nastomotaic recurrence significantly.The rate of local recurrence in the washout group was significantly lower than that in the no washout group [5.8% vs 10.1%; RR=0.57,95% CI:0.46~0.71,P < 0.00001)].The intraoperative rectal washout was not effective on anastomotic recurrence rate after rectal cancer surgery.Subgroup analysis showed the effect of using TME surgery for rectal washout on local recurrence of rectal cancer with an overall local recurrence rate of 6.7%.The rate of local recurrence in the washout group was significantly lower than that in the no washout group [5.8% (230/3 971)vs 10.1% (114/1 127); RR=0.53, 95%CI:0.41 ~ 0.67,P < 0.01)].Conclusion From the results of this Meta-analysis, it may be justified to recommend intraoperative rectal washout to prevent local recurrence in rectal cancer surgery.
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