腹腔镜右半结肠切除术中的体腔内吻合与体外吻合：随机对照试验的最新系统回顾和 Meta 分析》。

IF 1.8 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Digestive Surgery Pub Date : 2024-09-27 DOI:10.1159/000541373

Pengyu Wei, Yang Li, Jiale Gao, Si Wu, Wenlong Shu, Hongwei Yao, Zhongtao Zhang

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引用次数: 0

摘要

简介：腹腔镜右半结肠切除术是治疗右半结肠疾病的标准方法，但对于选择体腔内吻合术还是体腔外吻合术仍存在争议。本研究比较了两者的安全性和有效性。方法截至 2023 年 6 月 4 日，我们在 PubMed、Embase、Web of Science 和 Cochrane Library 中对比较腹腔镜右半结肠切除术中这两种吻合技术的随机对照试验进行了系统检索。主要结果是30天内的吻合口渗漏。使用Review Manager（5.4.1版）进行统计分析。结果共纳入 7 项研究，涉及 720 名患者。各组间吻合口漏率无明显差异（RR 0.93，95% CI 0.49-1.76，P=0.83）。不过，体腔内吻合术的术后回肠梗阻率（RR 0.67，95% CI 0.45-0.99；P=0.04）和手术部位感染率（RR 0.34，95% CI 0.16-0.74；P=0.007）较低。采用体腔内吻合术的患者肠道功能恢复更快（气体通过率：WMD -0.39，p=0.0002；粪便通过率：WMD -0.53，p=0.001），住院时间更短（WMD -0.46，p=0.001）。结论与体外吻合术相比，体外吻合术不会增加吻合口漏的风险，并能促进肠道更快恢复。它是一种安全有效的选择。

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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Intracorporeal versus Extracorporeal Anastomosis in Laparoscopic Right Hemicolectomy: An Updated Systematic Review and Meta-Analysis of Randomized Control Trials.

Introduction: Laparoscopic right hemicolectomy has become the standard surgical procedure for the treatment of right colon disease; however, the choice of anastomosis remains controversial. This study aimed to compare the safety and efficacy of intracorporeal anastomosis and extracorporeal anastomosis in laparoscopic right hemicolectomy.

Methods: A systematic literature search was performed in PubMed, Embase, Web of Science, and Cochrane Library. Randomized controlled trials that compared intracorporeal anastomosis with extracorporeal anastomosis in patients with laparoscopic right hemicolectomy until June 4, 2023, are selected. The primary outcomes measured were incidence of anastomotic leakage within 30 days post-operation. Statistical analyses were performed using Review Manager (version 5.4.1).

Results: Seven RCTs, including 720 patients, were eligible for the meta-analysis. The incidence of anastomotic leakage showed no significant difference between the intracorporeal anastomosis group and the extracorporeal anastomosis group (RR 0.93, 95% CI: 0.49, 1.76, p = 0.83, and I2 = 0%). However, the intracorporeal anastomosis group had significantly lower rates of postoperative ileus (RR 0.67, 95% CI: 0.45-0.99, p = 0.04, I2 = 46%) and surgical site infections (RR 0.34, 95% CI: 0.16-0.74, p = 0.007, I2 = 0%) compared to the extracorporeal anastomosis group. Additionally, patients in the intracorporeal anastomosis group experienced earlier postoperative passage of gas and stool (WMD -0.39, 95% CI: -0.60, -0.19, p = 0.0002, and I2 = 67%; WMD -0.53, 95% CI: -0.85, -0.21, p = 0.001, and I2 = 75%), as well as shorter hospital stays (WMD -0.46, 95% CI: -0.74, -0.18, p = 0.001, and I2 = 34%).

Conclusion: In laparoscopic right hemicolectomy, intracorporeal anastomosis does not increase the incidence of anastomotic leakage within 30 days post-operation compared to extracorporeal anastomosis. In addition, intracorporeal anastomosis resulted in faster recovery of bowel function. This suggests that intracorporeal anastomosis is safe and effective.

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来源期刊

Digestive Surgery 医学-外科

CiteScore

4.90

自引率

3.70%

发文量

审稿时长

3 months

期刊介绍： ''Digestive Surgery'' presents a comprehensive overview in the field of gastrointestinal surgery. Interdisciplinary in scope, the journal keeps the specialist aware of advances in all fields that contribute to improvements in the diagnosis and treatment of gastrointestinal disease. Particular emphasis is given to articles that evaluate not only recent clinical developments, especially clinical trials and technical innovations such as new endoscopic and laparoscopic procedures, but also relevant translational research. Each contribution is carefully aligned with the need of the digestive surgeon. Thus, the journal is an important component of the continuing medical education of surgeons who want their practice to benefit from a familiarity with new knowledge in all its dimensions.