目的:本系统综述和荟萃分析旨在比较溃疡性结肠炎和家族性腺瘤性息肉病患者的吻合回肠袋-肛门吻合术(IPAA)和手工缝制IPAA粘膜切除术的结局。
方法:本系统评价和荟萃分析是根据系统评价和荟萃分析的首选报告项目2020指南和AMSTAR2(评估系统评价的方法学质量)指南进行的。我们纳入了随机临床试验(RCT)和对照临床试验(CCT)。根据手术指征进行亚组分析。
结果:书目研究产生了31项试验:3项RCT,5个前瞻性临床试验,24例CCT,包括8872例患者:缝合组4871例,手工缝制组4038例。关于术后结果,钉组吻合口狭窄发生率较低,小肠梗阻,和回肠袋失败。两组在手术时间上无差异,吻合口漏,盆腔脓毒症,囊炎,或住院。对于功能性结果,在每天和晚上的渗漏方面,装订组与更大的结果相关,垫使用,夜间尿失禁,静息压力,挤压压力。每24小时大便频率没有差异,夜间大便频率,止泻药,性阳痿,或高压区的长度。两组在异型增生和瘤形成方面没有差异。
结论:与手工缝合吻合相比,吻合回肠吻合术导致吻合口狭窄大量减少,小肠梗阻,回肠囊衰竭,白天和黑夜的渗漏,垫使用,和夜间失禁。这可以确保在测压评估中更高的静止压力和挤压压力。
背景:该协议在PROSPERO的CRD42022379880下注册。
OBJECTIVE: This systematic review and meta-analysis aimed to compare outcomes between stapled ileal pouch-anal anastomosis (IPAA) and hand-sewn IPAA with mucosectomy in cases of ulcerative colitis and familial adenomatous polyposis.
METHODS: This systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Review and Meta-analysis) guidelines 2020 and AMSTAR 2 (Assessing the methodological quality of systematic reviews) guidelines. We included randomized clinical trials (RCTs) and controlled clinical trials (CCTs). Subgroup analysis was performed according to the indication for surgery.
RESULTS: The bibliographic research yielded 31 trials: 3 RCTs, 5 prospective clinical trials, and 24 CCTs including 8872 patients: 4871 patients in the stapled group and 4038 in the hand-sewn group. Regarding postoperative outcomes, the stapled group had a lower rate of anastomotic stricture, small bowel obstruction, and ileal pouch failure. There were no differences between the 2 groups in terms of operative time, anastomotic leak, pelvic sepsis, pouchitis, or hospital stay. For functional outcomes, the stapled group was associated with greater outcomes in terms of seepage per day and by night, pad use, night incontinence, resting pressure, and squeeze pressure. There were no differences in stool Frequency per 24h, stool frequency at night, antidiarrheal medication, sexual impotence, or length of the high-pressure zone. There was no difference between the 2 groups in terms of dysplasia and neoplasia.
CONCLUSIONS: Compared to hand-sewn anastomosis, stapled ileoanal anastomosis leads to a large reduction in anastomotic stricture, small bowel obstruction, ileal pouch failure, seepage by day and night, pad use, and night incontinence. This may ensure a higher resting pressure and squeeze pressure in manometry evaluation.
BACKGROUND: The protocol was registered at PROSPERO under CRD 42022379880.