骶前冲洗对直肠前切除术后局部复发影响的Meta分析

目的探讨骶前冲洗对直肠前切除术后局部复发的影响。方法采用Meta分析软件对1980年1月～2011年1月间发表的骶前冲洗对直肠癌前切除术局部复发影响的文献进行分析。结果共筛选出6篇文献(其中1篇文献有77名患者未确定分组,10名局部复发,67名无复发);直肠癌术后局部复发率为7.7%(367/4776),冲洗组局部复发率为6.4%(240/3732),低于未冲洗组的12.2%(127/1044),合并OR值为0.51(95%CI:0.41～0.69),差异有统计学意义(P<0.01);未确定人数并入冲洗组或未冲洗组,总局部复发率为7.8%(377/4852),冲洗组局部复发率6.6%(250/3 808)或6.4%(240/3 732),低于未冲洗组的12.2%(127/1 044)或12.3%(137/1 111),合并OR值为0.51(95%CI:0.40～0.65)或0.49(95%CI:0.39～0.62),差异有统计学意义(P<0.01)。结论骶前冲洗可降低直肠癌的局部复发率。

The effect of rectal washout during anterior resection for prevention local tumor recurrence:a meta-analysis

Objective To investigate the effect of rectal washout(WO) for the prevention of local recurrence(LR) in patients with resectable rectal cancer. Methods Relevant studies that compared rectal WO with no washout(NWO) for rectal cancer resection and were published between January 1980 and January 2011 were retrieved.Random-effect meta-analysis was used and subgroup analysis was performed. Results Of the six studies that matched the selection criteria,one reported 10 patients with LR and 67 patients without LR within 5 years,who were unknown to belong to WO group or NWO group,with an overall LR rate of 7.7 percent(367/4 776).LR rate in the WO group was 6.4 percent(240/3 732) as compared with 12.2 percent(127/1 044) in the NWO group,with a significant difference(OR=0.51,95 percent CI=0.41-0.69,P<0.01).When incorporating the 10 patients with LR into the WO group or into the NWO group,LR rate was higher in the NWO group than in the WO group,with an overall LR rate of 7.8 percent(377/ 4 852),12.2 percent(127/1 044) vs.6.6 percent(250/3 808) or 12.3 percent(137/1 111) vs.6.4 percent(240/3 732),respectively,and there were significant differences between them(OR=0.51,95 percent CI=0.40-0.65,P<0.01;OR=0.49,95 percent CI=0.39-0.62,P<0.01). Conclusion As a relatively risk-free procedure,rectal washout during anterior resection can effectively prevent the local recurrence rate of rectal cancer.