背景:本系统评价和荟萃分析的目的是评估临床,功能,直肠癌前切除术后侧端与结肠J袋(CJP)吻合术的肛门直肠生理学结果。
方法:使用多个电子数据库和临床试验注册进行符合PRISMA的系统评价和荟萃分析,并纳入了比较侧端吻合术与CJP吻合术的所有研究。围手术期并发症,死亡率,功能性肠,并对肛门直肠结局进行评估。
结果:共纳入8项随机对照试验(RCT)和2项观察性研究,共1125例患者(侧端:n=557;CJP:n=568)。在分析的整个功能性肠道结果参数中,在6个月时,CJP组只有肠排空不全的感觉是显著的[OR:2.07;95%CI1.06-4.02,P=.03]。两组的围手术期和术后临床参数具有可比性(总手术时间,术中失血,吻合口漏率,回到剧院,吻合口狭窄的形成和死亡率)。同样,大多数分析的肛门直肠生理参数(肛门直肠体积,肛门挤压压力,最大肛门体积)两组之间没有显着差异。然而,术后2年,侧端组肛门静息压(mmHg)显著高于CJP组[MD:-8.76;95%CI-15.91-1.61,P=.02].
结论:CJP手术和侧端结肠肛门吻合术后的临床和功能结果具有可比性。这两种技术似乎都不能在短期内提供低前切除综合征的解决方案,但未来的设计良好;需要长期随访的高质量随机对照试验。
BACKGROUND: The aim of this systematic review and meta-analysis is to evaluate clinical, functional, and anorectal physiology outcomes of the side-to-end vs colonic J-pouch (CJP) anastomosis following anterior resection for rectal cancer.
METHODS: A PRISMA-compliant systematic review and meta-analysis was conducted using multiple electronic databases and clinical trial registers and all studies comparing side-to-end vs CJP anastomosis were included. Peri-operative complications, mortality rate, functional bowel, and anorectal outcomes were evaluated.
RESULTS: Eight randomized controlled trials (RCTs) and two observational studies with 1125 patients (side-to-end: n = 557; CJP: n = 568) were included. Of the entire functional bowel outcome parameters analyzed, only the sensation of incomplete bowel evacuation was significant in the CJP group at 6 months [OR: 2.07; 95% CI 1.06 - 4.02, P = .03]. Peri- and post-operative clinical parameters were comparable in both groups (total operative time, intra-operative blood loss, anastomotic leak rate, return to theater, anastomotic stricture formation and mortality). Equally, most of the analyzed anorectal physiology parameters (anorectal volume, anal squeeze pressure, maximum anal volume) were not significantly different between the two groups. However, anal resting pressure (mmHg) 2 years post-operatively was noted to be significantly higher in the side-to-end group than that of the CJP configuration [MD: -8.76; 95% CI - 15.91 - 1.61, P = .02].
CONCLUSIONS: Clinical and functional outcomes following CJP surgery and side-to-end coloanal anastomosis are comparable. Neither technique appears to proffer solution to low anterior resection syndrome in the short term but future well-designed; high-quality RCTs with long term follow-up are required.