| Rectal cancer is a common digestive system tumor in gastrointestinal surgery.It is widely valued by surgeons.On the basis of complete tumor resection,it can reduce the trauma of surgery,reduce the risk of surgery,improve the aesthetics of surgery,and improve the quality of life of patients.The goal of the surgeon's constant struggle.The Global Cancer Epidemiology Statistics(GLOBOCAN 2012),as measured by the World Health Organization(WHO)in 2012,shows that the incidence of colorectal cancer ranks third in the world,second only to lung cancer and breast cancer [1],and has been seriously threatened.The health of human beings all over the world.With the continuous advancement of the society,the people's living standards have increased accordingly,and the medical examination has become more and more popular and standardized.A large number of patients with colorectal cancer have been detected,according to the 2015 China Cancer Statistics: at all Among the malignant tumors,the incidence of colorectal cancer was ranked fifth,while that of women was fourth,while that of men and women was the same,both ranked fifth.It is suggested that the number of new cases of colorectal malignant tumors is still at a high level,and it is on the rise.At the same time as the rapid development of modern medicine,advanced treatment technologies including neoadjuvant chemotherapy and molecular targeted therapy are emerging one after another.However,the most effective treatment for colorectal cancer still relies on surgical resection,in total mesenteric resection(TME).On the basis of this,gastrointestinal surgery has undergone a transition from laparotomy to laparoscopic surgery.Under the effect of minimally invasive surgery,surgeons have stricter requirements for reducing surgical trauma,promoting postoperative recovery,and increasingthe aesthetics of surgery.Surgical instruments It is also constantly fine,and minimally invasive surgery represented by laparoscopy is widely practiced in hospitals at all levels.Especially in the treatment of colorectal cancer,laparoscopic surgery has become one of the routine operations to measure the technical level of surgeons.A large number of literature and control studies have shown that the radical cure of laparoscopic rectal anterior resection is reliable.Compared with conventional laparotomy,laparoscopic surgery is more minimally invasive,less surgical trauma,and faster postoperative gastrointestinal function adjustment.The surgical incision is more beautiful,and the patient can get out of bed in the early stage of general activities,and also has a positive effect on the recovery of organs such as heart and lung.However,how to prevent anastomotic leakage is still unresolved.In the open surgery,some surgeons avoid this problem by preventive intestinal fistula,but whether it is suitable for laparoscopic surgery and whether it has been controversial has been controversial [2] ].This article aims to collect data on prophylactic enterospasm by collecting literature on laparoscopic rectal anterior resection at home and abroad,and compare its impact on patient outcomes,including anastomotic leakage and reoperation.The length of hospital stay,postoperative peritonitis and wound infection,etc.,to evaluate the value of routine use of prophylactic enteritis in laparoscopic surgery,in order to serve clinical work.Objective:Systematic evaluation of preventive measures by comparing the incidence of postoperative anastomotic leakage,perioperative reoperation rate,hospitalization time,postoperative peritonitis rate,and postoperative incision infection rate in laparoscopic surgery The surgical effect of bowel fistula or not,in order to serve clinical treatment.Methods:Develop corresponding literature inclusion standards and strictly enforce them,and exclude them according to the corresponding exclusion criteria,such as “rectal cancer”,“preventive intestinal fistula”,“laparoscopic surgery”,“intestinal fistula” and “anastomotic fistula”.Search terms are searched for the combination of subject terms and free words.The search period is set from the beginning of the database construction to March 2018.Search for Pubmed,Cochrane Library,Embase,WanFang Date,CNIK database,and pay attention to the "grey literature".Manual search.A randomized controlled trial(RCT)or non-RCT literature was performed comparing laparoscopic anterior resection of rectal cancer with preventive enterostomy and without prophylactic enterospasm.Two researchers independently conducted literature screening,data extraction,and evaluation of document quality.When there was disagreement,a third researcher participated in the discussion and made a decision.Statistical analysis of the data was performed using Review Manager(RevMan)5.3 software.Calculate the mean difference(WMD)or normalized mean difference(SMD)for the continuous data,calculate the odds ratio(OR)for the binary data,and calculate the point estimate and 95% confidence interval(CI)for each effect.The heterogeneity of the included literature was tested by the I2 test: when the heterogeneity was small,the fixed effect model was applied;otherwise,the random effects model was used.If the heterogeneity is large,the heterogeneity source is further explored and processed by subgroup analysis and other methods.Finally,the literature bias is evaluated based on the funnel plot.Result:A total of 16 articles were included in the literature,with a total of 4029 cases.Among them,1484 were in the preventive ostomy group(experimental group)and 2566 in the non-surgical group(control group).Meta-analysis showed that the incidence of anastomotic leakage was significantly lower in the laparoscopic rectal anterior resection than in the non-surgical group(OR=0.45,95% CI: 0.28-0.72,P<0.05).The average hospital stay was shorterthan the non-surgical group(MD=-5.81,95% CI:-6.88 to-4.74,P<0.05).The incidence of postoperative peritonitis was lower in the ostomy group(OR=0.22,95% CI: 0.10-0.47,P<0.05).The infection rate of incision in the sputum group was similar to that in the non-surgical group(OR=0.85,95% CI:0.33~2.14,P>0.05).There was no significant difference in the perioperative reoperation rate between the two groups(OR=0.61,95% CI: 0.33 to 1.14,P>0.05).The results of the funnel plot suggest that the scatter points are located in the funnel plot,scattered on both sides of the vertical axis,and the distribution is basically symmetrical,indicating that the publication bias may be small.Conclusion :Prophylactic enterospasm is valuable in laparoscopic anterior resection of rectal cancer.It can not only reduce the occurrence of anastomotic leakage,but also shorten the length of hospital stay.Preventive bowel fistula can be performed in patients with poor general condition and high risk.The results of this study show that preventive intestinal fistula does not significantly reduce the perioperative reoperation rate,and the impact on other complications is not clear,and most patients with ostomy need to undergo secondary surgery to increase the surgical trauma and Risks and increased medical costs are not recommended for routine bowel fistula in patients with better general conditions and lower risk.In summary,it is not recommended to routinely perform preventive intestinal fistula in laparoscopic rectal anterior resection,but to select the appropriate surgical method based on the general condition of the patient. |
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