腹腔镜下直肠癌腹会阴联合切除术后复发和生存的Meta分析  

Five - year recurrence and survival rate of rectal cancer patients after laparoscopic abdominoperineal resection ：a meta - analysis

作　　者：张纪伟[1] 徐佶[1] 李金明[1] 王中川[1] 黄士勇[1] 杜鹏[1] 杨明[1] 崔龙[1] 

机构地区：[1]上海交通大学结直肠癌诊治中心；上海交通大学医学院附属新华医院肛肠外科,200092

出　　处：《临床外科杂志》2011年第8期534-537,共4页Journal of Clinical Surgery

基　　金：上海市科委基础研究重点项目（09JC1410900）

摘　　要：目的评价腹腔镜直肠癌腹会阴联合切除术（LAPR）的根治性。方法在Pubmed、Cochrane library和EMbase等数据库中检索1990年至2010年间发表的有关腹腔镜直肠癌腹会阴联合切除术的文献，由两位独立的研究人员进行文献筛选和数据提取，采用RevMan4．2软件进行荟萃分析。结果2项随机对照研究和4项非随机对照研究，共500例患者，符合入选标准。LAPR手术组术后5年总复发率与开腹直肠癌前切除术（OAPR）组差异无统计学意义（27．5％与32．0％，P=0．67）；LAPR组术后5年局部复发率与OAPR组差异无统计学意义（10．8％与18．2％，P=0．28）；LAPR组术后5年总生存率高于OAPR组（63．7％与41．2％，P=0．02），术后5年无病生存率两组差异无统计学意义（79．7％与75％，P=0．50）。结论腹腔镜直肠癌腹会阴联合切除术后5年的生存率不低于开腹手术，复发率不高于开腹手术。Objective To assess the five -year survival and recurrence rate of rectal cancer patients after laparoscopic abdominoperineal resection （ LAPR ） versus open abdominoperineal resection （OAPR）. Methods All studies in English or Chinese on LAPR and rectal cancer published between 1990 and 2009 were identified through searches of Pubmed, Cochrane library, EMbase, Elsevier, and so on. Two independent assessors reviewed the studies using critical criteria. Where raw data were extracted, meta - analysis was performed using the RevMan 4.2 software. Results Two randomized controlled trials and four non - randomized controlled studies in 500 patients were qualified for the meta - analysis according to our criteria. The difference of 5 - year total recurrence between LAPR group and OAPR group was not sig- nificant（27.5% vs 32.0% ,OR = 0.91, P = 0.67 ） , and the difference of 5 - year local recurrence between LAPR and OAPR group was not significant（ 10.8% vs 18.2% ,OR =0.74 ,P =0.28） either. However ,the difference of 5 - year overall survival between LAPR and OAPR group was significant （ 63.7% vs 41.2% ,OR = 1.75 ,P =0.02） ; The difference of 5 - year disease free survival between LAPR and OAPR group was not significant （79.7 % vs 75 %, OR = 1.35, P = 0.50）. Conclusion The 5 - year recurrence of LAPR patients was not higher than that of OAPR patients, and the 5 - year survival rate was not lower than OAPR patients.

关 键 词：直肠癌腹会阴联合切除术 腹腔镜 生存率 复发率 META分析 

分 类 号：R735.37[医药卫生—肿瘤]