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背景和目的癌细胞脱落种植可能是引起结直肠吻合口复发的原因,因此临床建议直肠癌手术术中行肠腔灌洗以清除游离癌细胞,直到目前仍没有确切证据证实术中肠腔灌洗可以降低局部复发率。本研究就直肠癌术中肠腔灌洗对吻合口复发的影响进行荟萃分析。方法通过电子文献搜索并甄别2012年2月以前发表的有关术中肠腔灌洗对局部复发或吻合器切除环组织(donuts)清洗液细胞学阳性影响的相关文献。直肠术中灌洗的标准过程包括在肿瘤与预定吻合部位间钳夹阻断直肠,充分经肛门冲洗远端直肠。局部复发通过影像学、内镜结合直肠指检诊断。吻合环组织清洗液细胞学检查步骤包括吻合器击发、生理盐水冲洗吻合环和清洗液收集送细胞学检查。使用DerSimonian-Laird随机效应模型进行荟萃分析,计算风险比(RR)以及95%置信区间(CI)。结果共有9项研究符合入选标准,共计5 395例患者。其中8项研究评价总体局部复发率包括吻合口复发率;8项研究中的5项对吻合口复发率进行了单独评价。两项研究对吻合环洗出液细胞学阳性结果进行了评价。术中灌洗组局部复发率5.79%,而无灌洗组为10.05%,差异有统计学意义(RR=0.57;95%CI:0.46-0.71;P<0.00001)。直肠灌洗可以显著降低吻合口复发风险(RR=0.3;95%CI:0.12-0.71;P=0.007)。直肠灌洗对吻合环清洗液细胞学阳性结果无影响。结论根据该荟萃分析,在直肠癌手术中推荐进行术中肠腔灌洗以预防局部复发。
BACKGROUND & OBJECTIVE: Exfoliative implantation of cancer cells may be responsible for the recurrence of colorectal anastomosis. Therefore, it is advisable to perform intestinal lumen irrigation to remove free cancer cells during the operation of rectal cancer surgery. Up to now, there is still no conclusive evidence that intraoperative lumen lavage can be performed Reduce the local recurrence rate. This study conducted a meta-analysis of the effect of intra-operative lavage on recurrence of anastomotic stoma in rectal cancer. Methods The literature review and screening of relevant literature published before February 2012 on the positive effects of intraoperative enteral lavage on the cytology of locally recurrent or stapler excised donuts was performed. Standard procedures for rectal lavage include clamping the rectum with a clamp between the tumor and the intended anastomotic site and flushing the distal rectum extensively through the anus. Local recurrence through imaging, endoscopy combined with digital rectal examination. Anastomosis loop tissue cleaning fluid cytological examination procedures include stapling, saline flushing anastomosis rings and cleaning fluid collection for cytology. A meta-analysis using the DerSimonian-Laird random effects model was performed to calculate the hazard ratio (RR) and the 95% confidence interval (CI). Results A total of 9 studies met the inclusion criteria for a total of 5 395 patients. Eight of the studies evaluated the overall local recurrence rate as anastomotic recurrence rate; five of the eight studies evaluated the recurrence rate of the anastomotic stoma individually. Two studies evaluated the positive results of anastomosis loop eluate cytology. The intraoperative lavage group local recurrence rate was 5.79%, but no lavage group was 10.05%, the difference was statistically significant (RR = 0.57; 95% CI: 0.46-0.71; P <0.00001). Rectal lavage significantly reduced the risk of anastomotic recurrence (RR = 0.3; 95% CI: 0.12-0.71; P = 0.007). Rectal lavage had no effect on positive results of anastomosis loop cytology. Conclusions Based on this meta-analysis, intraoperative luminal irrigation is recommended for the prevention of local recurrence in rectal cancer surgery.