| Objective:By comparing the middle or low rectal cancer colostomy and obstructed left hemicolon cancer line whether intraoperative colonic irrigation the incidence of postoperative anastomotic fistula,operative time,postoperative exhaust time,for the first time fistula after the second operation rate,length of hospital stay,postoperative incision HaiNa related diseases and other complications rate,mortality and quality of life in patients with im to evaluate preventive colostomy and intraoperative colonic irrigation in colorectal cancer,the application of value,which plays a role of reference for clinical practice.Methods:Formulate literature into and exclusion criteria set and retrieve the fixed number of year for nearly 10 years,and then through Pubmed search,Web of Science,Embase,the data knowledge service platform of ten thousand,China hownet resource pool and WeiPuZhongWen sci-tech periodicals database to get and study the related literature,and then extract the required data,finally using RevMan5.2 software to analyze data.Among them,MD OR SMD were used for continuous data,OR OR was used for dichotomous data,and the point estimates and 95% confidence intervals(CI)of each effect quantity were calculated.Finally,I2 was used to test the heterogeneity of all the included literatures: when the heterogeneity was small,fixed effect model was used for analysis.On the contrary,the random effect model is used to analyze.When the heterogeneity is relatively large,its source is further explored and processed by eliminating included studies or subgroup analysis one by one,and finally,the publication bias of the literature is evaluated by funnel plot.Resuits:Section1 Ostomy and nonostomy in left hemicolon and middle or low rectal cancer:16 studies including 6326 patients(2 randomized controlled trials,14non-randomized controlled trials)were included.Among them,3315 were in the preventive ostomy group and 3011 in the non-surgical group.results showed that theincidence rate of anastomotic fistula preventive colostomy group was obviously decline(OR = 0.47,95% CI: 0.38-0.59,P < 0.00001),and secondary surgery rate significantly decreased(OR = 0.45,95% CI: 0.34-0.59,P < 0.00001),increased incidence of complications(OR = 1.44,95% CI: 1.03-2.00,P = 0.03).The mortality rates were similar between the two groups,with no statistical significance(OR= 0.70,95%CI: 0.29-1.71,P=0.44),and the length of hospitalization was not statistically significant(OR= 0.41,95%CI:-0.98-1.80,P=0.56Section2 Obstruction of the lavage portion of the left semicolon and rectal cancer:16 studies including 1175 patients(5 randomized controlled trials,9non-randomized controlled trials)were included.Among them,596 were in the preventive ostomy group and 579 in the non-surgical group.The results showed that the operation time of colon lavage group increased significantly(OR=20.15,95%CI:4.23-36.070),P<0.00001),the first postoperative exhaust time was not statistically significant(OR=0.27,95% CI:-0.18-0.71,P=0.24),and the hospitalization time decreased significantly(OR=-5.86,95%CI:-8.49 ?-3.23,P<0.0001).Complications decreased significantly(OR=0.51,95%CI:0.29-0.90,P=0.02),and deaths decreased(OR=0.27,95% CI: 0.08-0.94,P=0.04).Conclusions:Section1:Prophylactic ostomy can significantly reduce the incidence of anastomotic fistula,the rate of secondary surgery and improve the long-term quality of life of patients with left semicolon and rectal cancer,but it will increase the overall postoperative complication rate,and the postoperative mortality and length of stay of patients have nothing to do with the ostomy.Therefor,the use of prophylactic stoma is beneficial in clinic.Section2: Intraoperative colonic lavage can reduce Obstructive left semicolon and rectal cancer postoperative complications,length of stay and mortality of colorectal cancer,but can increase operative time.In general,the application of intraoperative colonic lavage in colorectal cancer is safe and feasible. |
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