Effect of ureterointestinal anastomosis on postoperative complications of patients with orthotopic neobladder: a Meta-analysis
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摘要: 目的:系统评价直接吻合与抗反流吻合输尿管肠管吻合术对原位膀胱患者术后并发症的影响。方法:检索PubMed、Web of Science、the Cochrane Library、中国知网、万方中文数据库,检索时间为建库至2020年3月发表的输尿管肠管吻合方式对原位膀胱患者术后并发症影响的相关文献。统计纳入文献的数据,并使用Revman5.3统计软件对统计数据进行Meta分析。结果:纳入文献11篇共1367例患者,行输尿管肠管直接吻合657例,24例发生吻合口狭窄;抗反流吻合710例,73例发生吻合口狭窄。行输尿管肠管抗反流吻合的患者术后吻合口狭窄率升高(OR=0.33,95%CI:0.21~0.54,P＜0.000 01),增加术后慢性肾损伤可能(OR=0.21,95%CI:0.07~0.59,P=0.003)。行直接吻合的患者术后输尿管反流率升高(OR=2.65,95%CI:1.75~4.02,P＜0.000 01),而两组在术后肾盂肾炎无明显差异(OR=1.00,95%CI:0.45~2.23,P=0.99)。结论:输尿管肠管抗反流吻合方式增加术后吻合口狭窄、慢性肾功能损伤的风险,直接吻合是一种术后并发症较少、值得推荐的吻合方式。Abstract: Objective: To systematically review the effects of direct anastomosis and antireflux anastomosis on postoperative complications of patients with orthotopic neobladder.Methods: PubMed, Web of Science, the Cochrane Library, China National Knowledge Infrastructure(CNKI), and Wanfang data were searched for relevant literature on the effect of ureteral intestinal anastomosis on postoperative complications of patients with orthotopic neobladder published from the database establishment to March 2020. The data of the included literature were collected, and the statistical software Revman 5.3 was used for Meta analysis of the statistical data.Results:A total of 1367 patients were included in 11 pieces of literature. Six hundred and fifty-seven patients underwent direct anastomosis, of which 24 had anastomotic stenosis, 710 had anti-reflux anastomosis and 73 had anastomotic stenosis. The incidence of anastomotic stenosis increased in patients undergoing ureteral intestinal antireflux anastomosis(OR=0.33, 95%CI: 0.21—0.54, P＜0.000 01), which increased the possibility of postoperative chronic kidney injury(OR=0.21, 95%CI: 0.07—0.59, P=0.003). The incidence of ureteral reflux increased in patients undergoing direct anastomosis(OR=2.65, 95%CI: 1.75—4.02, P＜0.000 01), while there was no significant difference between the two groups in postoperative pyelonephritis(OR=1.00, 95%CI: 0.45—2.23, P=0.99).Conclusion:Anti-reflux ureterointestinal anastomosis increases the risk of postoperative anastomotic stenosis and chronic renal injury. Direct anastomosis is a recommended method with few postoperative complications.
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