腹腔镜结直肠癌手术与传统开腹手术后复发率比较的Meta分析  

Laparoscopic versus conventional open resection for colorectal cancer： a Meta-analysis on recurrence

作　　者：梁毅超[1] 李国新[1] 陈平雁[2] 余江[1] 张策[1] 

机构地区：[1]南方医科大学附属南方医院普通外科,广州510515 [2]南方医科大学生物医学统计学系

出　　处：《中华胃肠外科杂志》2008年第5期414-420,共7页Chinese Journal of Gastrointestinal Surgery

基　　金：广东省科技计划基金项目（2006812901006）;广州市科技计划基金项目（2006Z3-E0571）

摘　　要：目的对比分析腹腔镜与开腹结直肠癌手术的术后复发率。方法以laparoscopy、surgery、minimal invasive、colon、intestine，large、colectomy、colonic neoplasms、rectal neoplasms和randomized controlled trial为检索词，检索1991年1月至2007年1月间发表的有关腹腔镜与开腹结直肠癌手术后复发的随机对照研究。按筛选标准，共有10篇研究入选。由3名作者各自独立地对入选研究中有关试验设计、研究对象特征和研究结果等内容进行摘录，并用RevMan4．2软件进行统计分析。结果全体研究样本量合计2474例结直肠癌。Meta分析结果显示：腹腔镜结直肠切除术对比开腹手术治疗结直肠癌的术后总体复发率差异无统计学意义，总体复发率合并优势比（OR）为0．95 [95％CI 0．76～1．19]，P=0．64。按不同复发类型进行独立研究，Meta分析结果显示：腹腔镜结直肠切除术治疗结直肠癌的术后局部复发率、远处转移率及穿刺口或切口种植转移率对比开腹手术均无显著升高，其OR分别为0．79[95％CI 0．50～1．25]，P=0．32和0．89[95％CI 0．62～1．28]，P=0．54及1．04[95％CI 0．21～5．27]，P=0．96。结论腹腔镜结直肠切除术对比传统开腹手术治疗结直肠癌其术后长期肿瘤学效果相当，并不会导致术后各类复发率明显升高，可成为治疗结直肠癌的标准术式。Objective To compare the recurrence between laparoscopic resection and conventional open resection for colorectal cancer with meta-analysis. Methods Eligible articles were identified by searches of MEDLINE, EMBASE and the Cochrane database between January 1991 and January 2007 using the terms （laparoscopy, surgery, minimal invasive, colon, intestine, large, colectomy, colonic neoplasms,rectal neoplasms and randomized controlled trial）. Prospective randomized clinical trials were eligible if they included patients with colorectal cancer treated by laparoscopic surgery versus open surgery followed-up by recurrence. Data were extracted from these trials by three independent reviewers. Results Ten trials with recurrence information of 2474 patients were involved. In the combined results, no significant difference in the OR for overall recurrence between the laparoscopic surgery and open surgery group was found （OR 0.95, 95%CI 0.76 to 1.19, P=0.64）. Stratified by recurrence type, the combined results of the individual reports showed no significant differences for local recurrence （OR 0.79, 95%CI 0.50 to 1.25,P=0.32）, distant metastasis （OR 0.89, 95%CI 0.62 to 1.28, P=0.54） and port-site or wound-site recurrence （OR 1.04,95%CI 0.21 to 5.27,P=0.96） between the two surgical techniques. Conclusion The recurrence rates for patients with colorectal cancer treated by laparoscopic surgery do not differ significantly from those by open surgery. Longer follow up studies will further define outcomes comparing the two techniques in the treatment of coloreetal cancer.

关 键 词：结直肠肿瘤 腹腔镜手术 开腹手术 复发 

分 类 号：R735.3[医药卫生—肿瘤]