经肛管不能预防直肠癌术后吻合口漏的发生：一项关于前瞻性研究的meta分析

Transanal Tube Does Not Prevent Postoperative Anastomotic Leak in Rectal Cancer: A Meta-Analysis of Prospective Studies

摘要: 经肛管(TT)是否能减少术后吻合口漏(AL)尚存在争议；我们研究的目的是比较直肠癌手术后放置TT和不放置TT的有效性和安全性。通过计算机检索PubMed和其他数据库中关于肛门导管预防直肠癌AL的文章：检索时限从建库到2022年2月28日。根据设定的标准，选择文献并提取相关数据，使用Review Manager 5.2和Stata 12.0软件进行数据分析。最终共纳入9项研究(2748名患者)，3项为随机对照试验(RCTs)，其余6项是前瞻性队列研究。在RCTs研究(OR, 0.67; 95%CI 0.39~1.13; P = 0.13)和前瞻性研究中(OR, 0.64; 95%CI 0.37~1.08; P = 0.09)，TT组和NTT组间的术后AL的发生率无明显的统计学差异。在RCTs的亚组分析中，TT组的再手术率(OR, 0.11; 95%CI 0.03~0.51; P = 0.004)及住院天数(OR, −3.40; 95%CI (−4.89, −1.91); P < 0.00001)优于NTT组；而在前瞻性研究中，2组间的死亡率(OR, 0.74; 95%CI 0.16~3.36; P = 0.70)、再手术率(OR, 0.72; 95%CI 0.37~1.42; P = 0.34)及住院天数(OR, −1.57; 95%CI −3.73~0.60; P = 0.16)均无统计学差异。这项meta分析表明，无论是RCTs研究还是前瞻性研究，TT组并未改善术后AL的发生率，未来需要更多的大型多中心研究进一步验证。

Abstract: Whether transanal catheters (TT) reduce postoperative anastomotic leakage (AL) is controversial; the aim of our study was to compare the effectiveness and safety of TT placement with and without TT placement after rectal cancer surgery. PubMed and other databases were searched by computer for articles on anal catheters for the prevention of AL in rectal cancer: the search period was from the date of database creation to 28 February 2022. The literature was selected and relevant data were extracted according to the set criteria, and data were analyzed using Review Manager 5.2 and Stata 12.0 software. A total of nine studies (2748 patients) were ultimately included: three were randomised controlled trials (RCTs) and the remaining six were prospective cohort studies. There was no statistically significant difference in the incidence of postoperative AL between the TT and NTT groups in the RCTs (OR, 0.67; 95%CI 0.39~1.13; P = 0.13) and in the prospective studies (OR, 0.64; 95%CI 0.37~1.08; P = 0.09). In a subgroup analysis of RCTs, the reoperation rate (OR, 0.11; 95%CI 0.03~0.51; P = 0.004) and hospital days (OR, −3.40; 95%CI (−4.89, −1.91); P < 0.00001) were better in the TT group than in the NTT group; whereas in the prospective study, the mortality rate between the 2 groups (OR, 0.74. 95%CI 0.16~3.36; P = 0.70), reoperation rate (OR, 0.72; 95%CI 0.37~1.42; P = 0.34) and days in hospital (OR, −1.57; 95%CI −3.73~0.60; P = 0.16) were not statistically different between the 2 groups in the prospective study. This meta-analysis suggests that the TT group did not improve the incidence of postoperative AL in either RCTs or prospective studies, and further validation in more large multicentre studies is needed in the future.