Apostolos Gaitanidis, Leonidas Kandilogiannakis, Eirini Filidou, Alexandra Tsaroucha, George Kolios, Michail Pitiakoudis
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引用次数: 0
摘要
背景:尽管外科技术取得了长足的进步，但吻合口漏(AL)是胃肠道手术后常见的并发症。干细胞是一种很有前途的治疗方法，可以改善愈合，并已用于胃肠道吻合。在这项研究中，我们进行了系统回顾和荟萃分析，以评估干细胞疗法在动物研究中预防ALs的功效。方法:通过检索PubMed、Web of Science和Cochrane Library对文献进行系统综述。我们考虑了从食道到直肠的胃肠道(不包括胆道)的所有吻合。结果包括术后第7天(POD)的AL率和报告的最新时间点。结果:14项研究对胃肠道吻合口的干细胞进行了评价，其中食管吻合口1项，胃吻合口2项，小肠2项，结直肠吻合口9项。meta分析未显示POD 7的AL发生率有显著差异(比值比[OR] 0.34, 95%可信区间[CI]: 0.04-3.15, p = 0.248, I2 = 34.1%， 95% CI: 0-75.2%， Q = 6.07, df = 4, p = 0.194)，但在最新报告的时间点AL发生率有较低的趋势(OR 0.28, 95% CI: 0.08-1.01, p = 0.052, I2 = 34%， 95% CI: 0-70.8%， Q = 10.6, df = 7, p = 0.157)。结论:干细胞治疗可能与胃肠道吻合口AL发生率降低有关，尽管meta分析受到异质性研究设计的严重抑制。需要更多的研究来确定干细胞的治疗潜力。
Stem Cell Therapies for Gastrointestinal Anastomotic Healing: A Systematic Review and Meta-Analysis on Results from Animal Studies.
Background: Despite considerable progress in surgical techniques, anastomotic leak (AL) is a common complication after gastrointestinal surgery. Stem cells are a promising therapy to improve healing and have been used in gastrointestinal anastomoses. In this study, we perform a systematic review and meta-analysis to evaluate the efficacy of stem cell therapies in preventing ALs among animal studies.
Methods: A systematic review of the literature was performed by searching PubMed, Web of Science, and the Cochrane Library. We considered all anastomoses of the gastrointestinal tract (excl. biliary) from the esophagus to the rectum. Outcomes included AL rates on postoperative day (POD) 7 and the latest time point reported.
Results: Fourteen studies were identified, evaluating stem cells in gastrointestinal anastomoses, of which 1 was on esophageal, 2 on gastric, 2 on small intestinal, and 9 on colorectal anastomoses. Meta-analysis did not show significant differences in AL rates on POD 7 (odds ratio [OR] 0.34, 95% confidence interval [CI]: 0.04-3.15, p = 0.248, I2 = 34.1%, 95% CI: 0-75.2%, Q = 6.07, df = 4, p = 0.194), but there was a nonsignificant trend for lower AL rates at the latest time point reported (OR 0.28, 95% CI: 0.08-1.01, p = 0.052, I2 = 34%, 95% CI: 0-70.8%, Q = 10.6, df = 7, p = 0.157).
Conclusion: Stem cell therapy may be associated with lower AL rates in gastrointestinal anastomoses, though meta-analysis is severely inhibited by heterogeneous study design. More studies are needed to determine the therapeutic potential of stem cells.
期刊介绍：
''European Surgical Research'' features original clinical and experimental papers, condensed reviews of new knowledge relevant to surgical research, and short technical notes serving the information needs of investigators in various fields of operative medicine. Coverage includes surgery, surgical pathophysiology, drug usage, and new surgical techniques. Special consideration is given to information on the use of animal models, physiological and biological methods as well as biophysical measuring and recording systems. The journal is of particular value for workers interested in pathophysiologic concepts, new techniques and in how these can be introduced into clinical work or applied when critical decisions are made concerning the use of new procedures or drugs.
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