腹腔镜与开腹全直肠系膜切除保肛术治疗低位直肠癌的Meta分析  

Meta analysis of laparoscopic versus open total mesorectal excision with sphincter-preservation for treating low rectal cancer

作　　者：李想[1] 傅仲学[1] 贾诩 

机构地区：[1]重庆医科大学附属第一医院胃肠外科,重庆400016

出　　处：《重庆医学》2015年第12期1658-1661,共4页Chongqing medicine

摘　　要：目的运用Meta分析评价腹腔镜全直肠系膜切除(TME)保肛手术治疗低位直肠癌的安全性及有效性。方法检索PubMed、Medline、Ovid、Cochrane Library、Controlled Trials Registry、中国生物医学文献服务系统(CBM)、万方数据库、中国知网数据库、维普等电子数据库。收集发表于2001~2012年关于腹腔镜与传统开腹TME保肛术治疗低位直肠癌的随机对照试验、非随机对照研究相关文献。Meta分析使用RevMan5.2软件。结果最后纳入12项研究,共1 508例,腹腔镜组781例;开腹组727例。结果显示,腹腔镜组较开腹组术中出血少[MD=-67.13,95%CI(-78.74^-55.51),P<0.01],肿瘤下缘距远切缘距离长[MD=0.15,95%CI(0.01~0.29),P=0.04],肛门第一次排气时间短[MD=-1.16,95%CI(-1.32^-1.01),P<0.01],住院时间短[MD=-3.99,95%CI(-5.36^-2.63),P<0.01],术后总并发症[OR=0.40,95%CI(0.25~0.63),P<0.01]、吻合口瘘[OR=0.60,95%CI(0.37~0.96),P=0.03]、尿潴留[OR=0.40,95%CI(0.18~0.87),P=0.02]及切口感染发生少[OR=0.26,95%CI(0.11~0.61),P=0.002]。两组在术中淋巴结清扫数目、切除标本长度、术后肠梗阻和2年总生存率等方面比较,差异无统计学上意义(P>0.05)。结论腹腔镜TME保肛术治疗低位直肠癌具有手术创伤小、术后恢复快、术后并发症少等优点,但其在术后肛门功能恢复情况及术后长期效果方面是否具有优势,还需做更进一步的研究证实。Objective To evaluate the safety and efficacy of laparoscopic total mesorectal excision（TME） with sphincter- preservation in the treatment of low rectal cancerby using meta analysis. Methods The electronic databases （PubMed,Medline,Ov- id, Coehrane Library, Controlled Trials Registry, SinoMedCBM, Wanfang Data, CNKI, VIP, et al） were retrieved. The related litera- tures on the randomized controlled trails （RCTs） and the non-randomized controlled trails（non-RCTs） comparing laparoscopic ver- sus laparotomy TME with sphincter-preservation for treating low rectal cancer published from January 2001 to October 2012 were collected. The RevMan5.2 software was used to conduct the meta analysis. Results Twelve studies including 1 508 patients were included,in which the laparoscopic group had 781 cases and the laparotomy group had 727 cases. The meta analysis results showed that compared with the laparotomy group,the laparoscopic TME（LTME） group with sphincter-preservation had significantly less estimated blood loss[mean difference（MD） = - 67.13,95 % confidence interval（CI） （ - 78.74, - 55.51）, P〈0.01], longer distal resection margins[MD= 0. 15,95% CI（O. 01,0. 29）, P = 0. 04], earlier intestinal functional reeovery[MD = - 1. 16, 95% CI （-1.32,-1.01）,P〈0.01] ,shorter hospital stay[MD=-3.99,95%CI （-5.36,-2.63）,P〈0.01）,less total morbidity[odds ratio（OR）=0.40,95%CI （0.25,0.63）,P〈0.01],anastomotic leakage[OR=0.60,95%CI （0.37,0.96）,P=0.03],urinary re- tention[OR= 0. 40,95%CI（0.18,0. 87） ,P=0.02] and incision infection[OR= 0. 26,95%CI（0.11,0. 61） ,P=0. 002]. The statis- tically significant differences were not found between the two groups in the number of lymph node dissections,length of resected specimen,postoperative obstruction and the 2-year overall survival rate（P〉0.05）. Conclusion LTME with sphincter-preservation for treating low rectal cancer has the advantages of less surgical trauma, rapid postoperative recovery and few complications. Never- t

关 键 词：腹腔镜 直肠肿瘤 全直肠系膜切除术 保肛手术 META分析 

分 类 号：R735.37[医药卫生—肿瘤]