预防性造口在直肠癌低位前切除术中的作用：Meta分析

**目的：**探讨预防性造口在直肠癌低位前切除术中的作用。

**方法：**检索中国知网、万方、维普、中国生物医学、Pubmed、Embase、CochraneLibrary数据库发表的相关研究进行Meta分析。

**结果：**纳入14篇随机对照研究（包括1298例低位直肠癌患者，其中行预防性造口患者665例，未行造口患者633例）综合分析。结果显示：对比未行预防性造口组，预防性造口组吻合口瘘率更低（RR=0.36，95％CI：0.25～0.52，P<0.00001），吻合口瘘再手术率更低（RR=0.32，95％CI：0.21～0.50，P<0.00001），术后并发症发生率更低（RR=0.57，95％CI：0.41～0.80，P=0.001），但吻合口狭窄发生率更高（RR=4.29，95％CI：1.69～10.88，P=0.002），吻合口瘘相关死亡率、除吻合口瘘外并发症及永久性造口发生率差异无统计学意义。

**结论：**预防性造口能够减少直肠癌低位前切除术后吻合口瘘、吻合口瘘再手术及并发症发生率，不能降低吻合口瘘相关死亡率，可能导致吻合口狭窄发生率升高，建议在直肠癌低位前切术中选择性应用预防性造口。

**内容：**注：本文翻译仅供学习交流使用，不得用于其他商业目的。

Objective: To investigate the role of prophylactic ostomy in low anterior resection for rectal cancer.

Methods: Relevant studies published in Chinese databases such as CNKI, Wanfang, VIP, China Biomedical, as well as Pubmed, Embase, and Cochrane Library were searched and included in a meta-analysis.

Results: Fourteen randomized controlled trials (including 1298 patients with low rectal cancer, 665 of whom received prophylactic ostomy and 633 did not) were included in the analysis. The results showed that compared with the non-prophylactic ostomy group, the prophylactic ostomy group had a lower anastomotic fistula rate (RR=0.36, 95% CI: 0.25-0.52, P<0.00001), a lower anastomotic fistula reoperation rate (RR=0.32, 95% CI: 0.21-0.50, P<0.00001), and a lower incidence of postoperative complications (RR=0.57, 95% CI: 0.41-0.80, P=0.001), but a higher anastomotic stricture rate (RR=4.29, 95% CI: 1.69-10.88, P=0.002). There was no statistically significant difference in anastomotic fistula-related mortality, other complications besides anastomotic fistula, and permanent ostomy rate.

Conclusion: Prophylactic ostomy can reduce the incidence of anastomotic fistula, anastomotic fistula reoperation, and postoperative complications after low anterior resection for rectal cancer, but it may increase the risk of anastomotic stricture. Therefore, it is recommended to selectively apply prophylactic ostomy in low anterior resection for rectal cancer.