腹腔镜下右半结肠癌根治术回结肠不同吻合方式疗效的Meta分析

Effectiveness of different anastomotic methods between the ileocolon in laparoscopic right hemicolectomy for colon cancer: a Meta-analysis

摘要:

目的 探究腹腔镜下右半结肠癌根治术回结肠行侧侧吻合（SS）与端侧吻合（ES）的临床疗效和安全性。方法 检索PubMed、Embase、Web of Science、Cochrane Library、中国知网、万方数据、维普网和中国生物医学文献数据库中，从建库到2024年11月发表的SS与ES对比的相关临床研究。筛选并提取文献资料后，采用纽卡斯尔-渥太华量表（NOS）评价回顾性研究的文献质量，Cochrane系统评价随机对照试验（RCT）的文献质量，Rev Man 5.3软件行Meta分析、敏感性分析和发表偏倚分析。结果 纳入9篇回顾性研究和4篇RCT，共2 632例患者。回顾性研究的Meta分析结果显示：与SS相比，ES的耐受流质时间短（MD = -0.20，95%CI：-0.40～0.00，P < 0.05），每日腹泻次数少（MD = -1.06，95%CI：-1.79～-0.23，P < 0.05），但术后12 h疼痛评分较高（MD = 0.95，95%CI：0.50～1.40，P < 0.05）。两种吻合方式的吻合口并发症总发生率比较，差异无统计学意义（OR＾ = 1.05，95%CI：0.22～5.14，P > 0.05）。回顾性研究的敏感性分析显示：ES肠梗阻发生率高于SS，差异有统计学意义（OR＾ = 2.18，95%CI：1.15～4.14，P < 0.05）；RCT的敏感性分析显示：SS的吻合口并发症总发生率明显高于ES，差异有统计学意义（OR＾ = 5.26，95%CI：1.91～14.48，P < 0.05），其余结局指标结果均未发生逆转。发表偏倚风险分析显示，未见明显发表偏倚。结论 腹腔镜下右半结肠癌根治术中，回结肠行ES较SS略有优势，两种吻合方式均是安全、有效的，手术医生可根据自身和患者具体情况，综合考虑，选择合适的吻合技术，以提高术后恢复效果。

Abstract:

Objective To explore the efficacy and safety of side-to-side anastomosis (SS) and end-to-side anastomosis (ES) of the ileocolon in laparoscopic right hemicolectomy of colon cancer, so as to provide evidence-based evidence for surgical selection.Methods PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data, VIP database, Chinese BioMedical Literature database were searched from inception to November 2024 to collect relevant clinical studies of SS versus ES. The Newcastle-Ottawa Scale (NOS) was used to evaluate the literature quality of retrospective studies, and the Cochrane system was used to evaluate the literature quality of randomized controlled trials (RCT). Rev Man 5.3 software was used for Meta-analysis, sensitivity analysis, and publication bias analysis.Results 9 retrospective studies and 4 RCTs with a total of 2 632 patients were included. The Meta-analysis results of the retrospective study show that: Compared with SS, ES has a shorter tolerance time for liquid diet (MD = -0.20, 95%CI: -0.40 ~ 0.00, P < 0.05), fewer daily episodes of diarrhea (MD = -1.06, 95%CI: -1.79 ~ 0.23, P < 0.05), but a higher pain score at 12 hours post-surgery (MD = 0.95, 95%CI: 0.50 ~ 1.40, P < 0.05).Comparison of the overall complication rates of the two anastomosis methods showed no statistically significant difference (OR＾ = 1.05, 95%CI: 0.22 ~ 5.14, P > 0.05). Sensitivity analysis of the retrospective study shows: the incidence of ES bowel obstruction was higher than that of SS, with a statistically significant difference (OR＾ = 2.18, 95%CI: 1.15 ~ 4.14, P < 0.05); The sensitivity analysis of the RCT shows: the overall incidence of complications at the anastomotic site of SS was significantly higher than that of ES, with a statistically significant difference (OR＾ = 5.26, 95%CI: 1.91 ~ 14.48, P < 0.05), and the results of other outcome indicators did not show reversal. The analysis of publication bias risk showed no significant publication bias.Conclusion Ileocolonic ES has a slight advantage over SS in laparoscopic right hemicolectomy of colon cancer, both anastomoses are safe and effective, and the surgeon can choose the appropriate anastomosis technique according to the patient’s specific situation, in order to improve the postoperative recovery.