经肛门内镜微创手术与标准经肛门局切术对直肠肿瘤疗效及安全性比较的系统评价  

Transanal endoscopic microsurgery versus traditional transanal excision for rectal neoplasms:systematic review

作　　者：王韬[1] 费建东[1] 聂双发[1] 武雪亮[1] 薛军[1] 

机构地区：[1]河北北方学院附属第一医院普外科,张家口075000

出　　处：《重庆医科大学学报》2016年第3期307-310,共4页Journal of Chongqing Medical University

基　　金：张家口市科技局指令性计划(1311055D);河北省科技支撑计划项目(152777237);河北省卫计委医学科学研究重点课题计划(20150058)

摘　　要：目的：比较肛门内镜微创手术和标准经肛门局切术治疗直肠肿瘤的疗效及安全性。方法：检索Pubmed、Embase、The Cochrane Library和中国期刊全文数据库及万方数据库中1990至2015年比较肛门内镜微创手术和标准经肛门局切术治疗直肠肿瘤的随机对照试验或对照试验。使用Rev Man 5.3软件对术后并发症发生率、切缘阴性率、样本破碎率及复发率进行meta分析。结果：共6篇文献927例患者入选研究,其中肛门内镜微创手术组492例,标准经肛门局切术组435例。分析显示肛门内镜微创手术组与标准经肛门局切术组术后并发症发生率（RR=0.92,95%CI=0.65-1.31,P=0.660）的差异无统计学意义。肛门内镜微创手术组切缘阴性率高于标准经肛门局切术组（RR=1.30,95%CI=1.06-1.58,P=0.010）。肛门内镜微创手术组样本破碎率（RR=0.16,95%CI=0.08-0.29,P=0.000）及复发率（RR=0.32,95%CI=0.22-0.46,P=0.000）低于标准经肛门局切术组。结论：肛门内镜微创手术作为一项安全、有效的手术方式,在提高切缘阴性率、降低样本破碎率及复发率方面优于标准经肛门局切术。Objective：To compare the efficacy and safety of transanal endoscopic microsurgery （TEM） and traditional transanal exci- sion（TAE） for rectal neoplasms. Methods：Randomized controlled trials（RCTs） or comparative studies comparing TEM with TAE for rectal neoplasms published from 1990 to 2015 were searched in Pubmed,Embase,The Cochrane Library and China National Knowl- edge Infrastructure（CNKI）,Wanfang Data. Review manager 5.3 was used for Meta-analysis and postoperative complication rate,neg- ative microscopic margins, specimen fragmentation and lesion recurrence were analyzed and compared. Results：A total of 6 studies including 927 patients were identified and analyzed. The results showed no significant difference in the postoperative complication rate （RR=0.92,95%CI=0.65 to 1.31 ,P=0.660）. The rate of negative microscopic margins was higher in TEM（RR=l.30,95%CI=1.06 to 1.58, P=0.010）. However, specimen fragmentation （RR=0.16,95%CI=0.08 to 0.29,P=-0.000） and lesion recurrence （RR=0.32,95%CI= 0.22 to 0.46,P=0.000） were more frequently observed in TAE group. Conclusion：TEM is superior to TAE in increasing negative microscopic margins and reducing specimen fragmentation and lesion recurrence.

关 键 词：肛门内镜微创手术 传统经肛门局切术 直肠肿瘤 META分析 系统评价 

分 类 号：R459.9[医药卫生—治疗学]