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中华结直肠疾病电子杂志 ›› 2024, Vol. 13 ›› Issue (06) : 472 -482. doi: 10.3877/cma.j.issn.2095-3224.2024.06.005

梗阻性结直肠癌专栏

肠梗阻支架置入术联合新辅助化疗治疗结直肠癌急性肠梗阻的疗效及其预后的Meta 分析
梁轩豪1, 李小荣1, 李亮1,(), 林昌伟1,()   
  1. 1.长沙 410013,中南大学湘雅三医院胃肠外科
  • 收稿日期:2024-10-29 出版日期:2024-12-25
  • 通信作者: 李亮, 林昌伟
  • 基金资助:
    湖南省科技创新计划项目(No.2022RC1218)湖南省卫生健康高层次人才重大科研专项资助(No.R2023037)中南大学教育教学改革研究项目(No.2022jy176)

Efficacy and prognosis of colonic stenting combined with neoadjuvant chemotherapy for acute obstructive colorectal cancer: a Meta-analysis

Xuanhao Liang1, Xiaorong Li1, Liang Li1,(), Changwei Lin1,()   

  1. 1.Department of Gastrointestinal Surgery, the Third Xiangya Hospital of Central South University, Changsha 410013, China
  • Received:2024-10-29 Published:2024-12-25
  • Corresponding author: Liang Li, Changwei Lin
引用本文:

梁轩豪, 李小荣, 李亮, 林昌伟. 肠梗阻支架置入术联合新辅助化疗治疗结直肠癌急性肠梗阻的疗效及其预后的Meta 分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 472-482.

Xuanhao Liang, Xiaorong Li, Liang Li, Changwei Lin. Efficacy and prognosis of colonic stenting combined with neoadjuvant chemotherapy for acute obstructive colorectal cancer: a Meta-analysis[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2024, 13(06): 472-482.

目的

比较肠梗阻支架置入术后行新辅助化疗和择期手术治疗结直肠癌致肠梗阻患者的疗效及其预后。

方法

检索中国知网、万方和维普文献数据库,收集自建库以来至2024 年9 月30 日期间公开发表的文献,搜集肠梗阻支架置入术后进行新辅助化疗的相关研究,独立筛查文献、提取资料并评价纳入研究的偏倚风险后采用R studio 软件进行Meta 分析。

结果

共纳入10 篇文献进行Meta 分析,“置入肠道支架后联合新辅助化疗后择期行手术”组(后文简称为新辅助治疗组)与“肠道支架置入后联合常规治疗后直接手术”组(后文简称为直接手术组)相比,新辅助治疗组腹腔镜手术率(OR=2.96,95%CI:1.72~5.10)、无病生存率(OR=2.15,95%CI:1.24~3.72)、总生存率(OR=1.92,95%CI:1.06~3.49)均明显高于直接手术组(P<0.05);而在造口率(OR=0.28,95%CI:0.16~0.48)、手术后并发症发生率(OR=0.41,95%CI:0.26~0.66)、局部复发率(OR=0.40,95%CI:0.20~0.82)、术中出血量(SMD=-1.24,95%CI:-2.09~-0.40)、手术后首次排气时间(SMD=-0.60,95%CI:-1.00~-0.21)、手术后住院时间(SMD=-1.12,95%CI:-1.57~-0.67)等方面新辅助治疗组均低于直接手术组(P<0.05)。

结论

置入肠道支架后联合新辅助化疗后再择期行手术治疗,比肠道支架置入后联合常规治疗后直接手术更加安全和有效。

Objective

To compare the efficacy and prognosis of neoadjuvant chemotherapy and elective surgery in the treatment of colorectal cancer induced intestinal obstruction after stent implantation.

Methods

The studies published from the establishment of the database to September 30, 2024,were searched from CNKI, Wanfang database, and VIP database.R studio software was used for data analysis.

Results

A total of 10 studies were included in this meta-analysis.Compared to direct surgery after intestinal stent implantation, elective surgery after intestinal stent implantation combined with neoadjuvant chemotherapy had significant higher laparoscopic surgeryrate(OR=2.96, 95%CI: 1.72~5.10), diseasefree survival rates(OR=2.15, 95%CI: 1.24~3.72), and overall survival (OR=1.92, 95%CI: 1.06~3.49) (P<0.05), and had significant lower ostomy rate(OR=0.28, 95%CI: 0.16~0.48), post-operative complications rate(OR=0.41, 95%CI: 0.26~0.66), local recurrence rate(OR=0.40, 95%CI: 0.20~0.82), intraoperative blood loss(SMD=-1.24, 95%CI: -2.09~-0.40), first postoperative exhaust time (SMD=-0.60, 95%CI: -1.00~-0.21) and length of stay after surgery (SMD=-1.12, 95%CI: -1.57~-0.67) (P<0.05).

Conclusion

Stent implantation combined with neoadjuvant chemotherapy is safer and more efficient than direct surgery after stent implantation combined with conventional treatment.

表1 纳入文献基本特征(x±s)
图1 文献筛选流程图
图2 风险偏倚评估图
图3 术中出血量的对比森林图
图4 手术时间的对比森林图
图5 造口率的对比森林图
图6 腹腔镜手术率的对比森林图
图7 手术后首次排气时间的对比森林图
图8 手术后并发症发生率的对比森林图
图9 手术后住院时间的对比森林图
图10 手术后3 年内局部复发率的对比森林图
图11 手术后3 年内无病生存率的对比森林图
图12 手术后3 年内总生存率的对比森林图
图13 新辅助化疗组和直接手术组手术后并发症发生率比较的Meta 分析漏斗图
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