腹腔镜手术治疗直肠癌疗效的Meta分析  

A meta-analysis of clinical outcomes after laparoscopic operation for rectal cancer

作　　者：龚涛[1] 周雄[1] 窦慧强[1] 张科明[1] 王彤[1] 

机构地区：[1]南京医科大学附属无锡市人民医院腔镜外科,214023

出　　处：《中华胃肠外科杂志》2010年第11期831-835,共5页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的 评价腹腔镜手术治疗直肠癌的疗效.方法 系统检索Medline、Embase、Cochrane中的相关文献,所有检索截止至2010年3月.由2名评价员独立筛选并提取数据资料,对符合纳入标准的研究使用RevMan5软件进行统计分析.对腹腔镜（LR）与开腹（OR）直肠癌手术的术中及术后情况进行比较分析.结果 共检索到1042篇文献摘要,通过筛选最终纳入16个临床对照研究,病例总数2850例,其中LR组1145例,OR组1705例.结果 显示,与OR组相比,LR组手术时间延长（WMD=42.50,95%CI：29.27～55.74,P＜0.05）、淋巴结检出数目减少（WMD=-0.94,95%CI：-1.47～-0.41,P＜0.05）、术中出血量减少（WMD=-158.46,95%CI：-221.08～-95.84,P＜0.05）、手术死亡率降低（OR=0.40,95%CI：0.18～0.92,P=0.03）、术后并发症发生率降低（OR=0.73,95%CI：0.61～0.87,P＜0.05）、5年总体生存率增高（OR=1.56,95%CI：1.21～2.02,P＜0.05）,两组环周切缘阳性率差异无统计学意义（OR=1.00,95%CI：0.45～2.20,P=1.00）.结论 腹腔镜直肠癌手术的短期和长期疗效均优于开腹手术.Objective To evaluate the clinical outcomes after laparoscopic surgery for rectal cancer.Methods A systematic literature search （Medline,Embase,Cochrane Library） as of March 2010 was performed to identify all eligible studies.Two reviewers independently screened and extracted the data.Differences in short-term and long-term clinical outcomes after laparoscopic resection （LR）and open resection （OR） were analyzed using RevMan 5.Results A total of 1042 abstracts were retrieved and 16 clinical controlled studies finally included.The total number of patients was 2850.There were 1145 patients received LR and 1705 received OR.The analyses showed that LR had longer operative time （WMD=42.50,95% CI：29.27 to 55.74,P〈0.05）,less harvested lymph nodes （WMD=-0.94,95% CI：-1.47 to -0.41 ,P〈0.05）,and less blood loss（WMD=-158.46,95% CI：-221.08 to -95.84,P〈0.05）as compared to OR.LR was superior to OR in terms of surgical mortality （OR=0.40,95% CI：0.18 to 0.92,P=0.03）,postoperative complications （OR=0.73,95% CI：0.61 to 0.87,P〈0.05）,and 5-year overall survival rate （OR=1.56,95% CI：1.21 to 2.02,P〈0.05）.There was no significant difference in positive rate of circumferential resection margin between the two groups（OR=1.00,95% CI：0.45 to 2.20,P=1.00）.Conclusion Compared to open surgery,short-term and longterm clinical outcomes after laparoscopic surgery are favorable.

关 键 词：直肠肿瘤 腹腔镜手术 开腹手术 META分析 

分 类 号：R735[医药卫生—肿瘤]