左侧恶性结直肠梗阻的内镜支架植入手术与急诊切除手术:最新的 Meta 分析。

IF 1.6 Q4 ONCOLOGY International Journal of Surgical Oncology Pub Date : 2017-01-01 Epub Date: 2017-07-05 DOI:10.1155/2017/2863272
Niccolò Allievi, Marco Ceresoli, Paola Fugazzola, Giulia Montori, Federico Coccolini, Luca Ansaloni
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引用次数: 0

摘要

简介:急诊切除术是治疗左侧恶性梗阻的传统方法:急诊切除术是治疗左侧恶性梗阻的传统方法。不过,也有人提出了放置自膨胀金属支架和延迟手术的替代方法。本荟萃分析旨在回顾现有证据,尤其关注短期疗效,包括最近的一项多中心 RCT:方法:我们在 MEDLINE、PubMed 数据库和 Cochrane 图书馆中进行了系统性综述,考虑了在处理左侧恶性大肠梗阻时将支架植入术作为手术桥梁与急诊手术进行比较的随机对照试验:我们初步确定了 2543 项研究。结果:我们最初共发现了 2543 项研究,在剔除重复研究并筛选了标题和摘要后,我们考虑了 7 项研究,共计 448 名患者。目前的荟萃分析显示,支架组和急诊手术组的死亡率没有差异;支架作为手术的桥梁后,术后并发症发生率(37.84% 对 54.87%,P = 0.02)、造口率(28.8% 对 46.02%,P < 0.0001)和伤口感染发生率(8.11% 对 15.49%,P = 0.01)均有所降低:结肠支架作为手术的桥梁似乎是治疗恶性大肠梗阻的一种安全方法。结肠支架作为手术桥梁似乎是一种安全的恶性大肠梗阻治疗方法,这种治疗方法的优势可能体现在术后并发症发生率降低和造口率降低。还需要进行更多的研究性试验,考虑长期疗效和成本效益分析。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Endoscopic Stenting as Bridge to Surgery versus Emergency Resection for Left-Sided Malignant Colorectal Obstruction: An Updated Meta-Analysis.

Introduction: Emergency resection represents the traditional treatment for left-sided malignant obstruction. However, the placement of self-expanding metallic stents and delayed surgery has been proposed as an alternative approach. The aim of the current meta-analysis was to review the available evidence, with particular interest for the short-term outcomes, including a recent multicentre RCT.

Methods: We considered randomized controlled trials comparing stenting as a bridge to surgery and emergency surgery for the management of left-sided malignant large bowel obstruction, performing a systematic review in MEDLINE, PubMed database, and the Cochrane libraries.

Results: We initially identified a total of 2543 studies. After the elimination of duplicates and the screening of titles and abstracts, seven studies, for a total of 448 patients, were considered. The current meta-analysis revealed no difference in the mortality rate between the stent group and the emergency surgery group; the postoperative complication rate (37.84% versus 54.87%, P = 0.02), the stoma rate (28.8% versus 46.02%, P < 0.0001), and the incidence of wound infection (8.11% versus 15.49%, P = 0.01) were reduced after stent as a bridge to surgery.

Conclusion: Colonic stenting as a bridge to surgery appears to be a safe approach to malignant large bowel obstruction. Possible advantages of this treatment can be identified in a reduced incidence of postoperative complications and a lower stoma rate. Further RCTs considering long-term outcomes and cost-effectiveness analysis are needed.

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来源期刊
CiteScore
3.70
自引率
0.00%
发文量
5
审稿时长
20 weeks
期刊介绍: International Journal of Surgical Oncology is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies in all areas of surgical oncology.
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