摘要
目的探讨病变肠管切除手术对比转流性肠造口手术治疗慢性放射性直肠损伤(RLRI)晚期并发症的疗效和安全性。方法从PubMed、Embase、Scopus、Web of Science、Cochrane Library、中国知网、中文科技期刊数据库、中国生物医学文献数据库、万方数字化期刊全文数据库检索有关病变肠管切除手术与转流性肠造口手术治疗RLRI严重并发症比较的研究。中文检索词为:"放射性肠损伤、放射性肠炎、手术"。英文检索词为:"Radiation-induced intestinal injury、Bowel injury from radiation、Radiation Proctitis、Surgery、Colostomy"。文献纳入标准:(1)国内外公开发表的、有关病变肠管切除手术与转流性肠造口手术对RLRI合并晚期严重并发症患者术后影响的试验设计、有对照组或临床描述性研究文献;(2)各文献中研究开展的年代清晰;(3)研究对象为术前诊断为RLRI合并顽固性出血、狭窄、梗阻、瘘、穿孔等晚期并发症患者;(4)病变肠管切除手术包括:Hartmann、Dixon、Bacon、Parks。转流性肠造口手术包括:回肠造口、结肠造口;(5)若同一机构或作者发表的研究开展时间相同的文献,选择其中研究样本量最大的一篇,但如果研究开展的时间不同(即研究对象不同)则可以都入选;(6)预后观察指标中至少包括症状改善情况、并发症、病死率、关瘘率中的一种。关瘘率的定义为病变肠管切除手术及转流性肠造口手术患者术后分别成功实施肠造口关闭的比率。其中,率的计算采用直接计算法或可以转化为直接计算法。排除标准:(1)无对照组的单臂研究;(2)研究对象包括首次手术非病变肠管切除或造口手术的患者;(3)有远处转移的晚期患者;(4)统计学处理方法不合理;(5)资料不完整,如研究中缺少预后观察指标。按以上标准筛选文献后,提取资料和质量评价,采用Review Manager 5.3软件进行Meta分析,采用敏感性分析对研究结果的稳定
radiation-induced intestinal injury,radiation proctitis,surgery.The following English terms were used to search:Radiation-induced intestinal injury,Bowel injury from radiation,Radiation proctitis,Surgery,Colostomy.Literature inclusion criteria:(1)studies with control groups,published at home and abroad publicly,about the postoperative effects of diseased bowel resection vs.diversion enterostomy on RLRI patients with late severe complications;(2)the period of the study performed in the literatures must be clear;(3)patients at the preoperative diagnosis for RLRI with refractory bleeding,narrow,obstruction,perforation or fistula,etc.;(4)diseased bowel resection included Hartmann,Dixon,Bacon and Parks;diversion enterostomy included colostomy and ileostomy;(5)if the studies were published by the same institution or authors at the same time,the study with the biggest sample size was chosen;studies conducted in different time with different subjects were simultaneously included;(6)at least one prognostic indicator of the following parameters should be included:the improvement of symptoms,postoperative complications,mortality,and reversed stomas rate.The stoma reduction rate was defined as the ratio of successful closure of colostomy after diseased bowel resection and diversion enterostomy.The method of direct calculation or the method of convert into direct calculation were used for stoma reduction rate.Exclusion criteria:(1)a single-arm study without control group;(2)RLRI patients did not undergo diseased bowel resection or diversion enterostomy at the first time;(3)RLRI patients with distant metastasis;(4)the statistical method in the study was not appropriate;(5)the information was not complete,such as a lack of prognosis in the observational indexes.After screening literatures according to criteria,data retrieval and quality evaluation were carried out.Review Manager 5.3 software was used for Meta-analysis.Sensitivity analysis was used to exam the stability of results.Funnel diagram was used to analyze the bias of p
作者
周佐霖
何炎炯
黄小艳
马腾辉
Zhou Zuolin;He Yanjong;Huang Xiaoyan;Ma Tenghui(Department of Colorectal Surgery,Division of Radiation Enterology,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor,Guangdong Institute of Gastroenterology,the Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou 510655,China)
出处
《中华胃肠外科杂志》
CSCD
北大核心
2021年第11期1015-1023,共9页
Chinese Journal of Gastrointestinal Surgery
基金
中山大学附属第六医院"1010"计划资助(1010PY(2020)-48)。
关键词
放射性直肠损伤
并发症
手术
结肠造口术
Radiation-induced late rectal injury
Complication
Surgery
Colostomy
