预防性造口在直肠癌低位前切除术中的作用：Meta分析

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

Methods: Relevant studies were retrieved from China National Knowledge Infrastructure (CNKI), Wanfang, VIP, China Biomedical Literature (CBM), PubMed, Embase, and Cochrane Library databases for meta-analysis.

Results: A total of 14 randomized controlled trials (including 1298 patients with low rectal cancer, 665 of whom underwent prophylactic ostomy and 633 did not) were included in the analysis. The results showed that compared with the group without prophylactic ostomy, the group with prophylactic ostomy had a lower anastomotic fistula rate (RR=0.36, 95% CI: 0.25-0.52, P<0.00001), a lower reoperation rate for anastomotic fistula (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 significant difference in anastomotic fistula-related mortality, non-anastomotic complications, and permanent ostomy rate between the two groups.

Conclusion: Prophylactic ostomy can reduce the incidence of anastomotic fistula, reoperation for anastomotic fistula, and postoperative complications after low anterior resection for rectal cancer. However, it does not reduce anastomotic fistula-related mortality and may increase the incidence of anastomotic stricture. Therefore, selective use of prophylactic ostomy is recommended in low anterior resection for rectal cancer.