腹腔镜下腹部无切口结直肠癌切除对比传统腹腔镜下结直肠癌切除可行性和安全性的Meta分析  

Laparoscopic-assisted resection for colorectal cancer without incision at abdomen versus traditional laparoscopic resection: A Meta-analysis

作　　者：杨小峰 苏文斌[2] 邓子清 王琦[2] 徐晓阳[2] 曹家庆[2] YANG Xiaofeng SU Wenbin DENG Ziqing WANG Od XU Xiaoyang CAO Jiaqing(First Department of General Surgery, Xingang Cenrtal Hospital, Xinyu Jiangxi 338000 Department of Gastrointestinal Surgery, Second Affiliated Hospital, Nanchang University, Nanchang 330006, China)

机构地区：[1]新钢中心医院普外1科,江西新余338000 [2]南昌大学第二附属医院胃肠外科,南昌330006

出　　处：《中南大学学报（医学版）》2017年第1期88-97,共10页Journal of Central South University ：Medical Science

摘　　要：目的:评价腹腔镜下腹部无切口结直肠癌切除术较之传统腹腔镜下结直肠癌切除术的可行性和安全性。方法:检索2005年8月至2015年8月公开发表的腹腔镜下腹部无切口结直肠癌切除对比传统腹腔镜下结直肠癌切除术应用情况的文献。按纳入标准筛选后进行质量评分,提取临床效应指标,采用Review Maneger 5.3软件对所纳入的数据进行Meta分析。结果:最终纳入7项研究,共621例患者,其中无辅助切口组(NOSE组)262例,传统腹腔镜组(LAP组)359例。Meta分析结果显示总并发症发生率的对比NOSE组明显较LAP组少(OR=0.31,95%CI:0.18~0.53,P<0.05)。对并发症进行亚组分析,其中切口并发症NOSE组较LAP组少(OR=0.15,95%CI:0.05~0.40,P=0.0002);术后出血(OR=1.52,95%CI:0.38~6.18,P=0.55)、肠梗阻(OR=0.30,95%CI:0.09~0.98,P=0.05)、吻合口相关并发症(OR=0.92,95%CI:0.28~3.07,P=0.89)、其他相关并发症(OR=0.63,95%CI:0.23~1.66,P=0.35)等亚组两组比较差异无统计学意义;住院时间(MD=–0.66,95%CI:–1.33~0.01,P=0.05)、手术持续时间(MD=14.78,95%CI:–1.75~31.31,P=0.08)、术中出血量(MD=–12.81,95%CI:–40.36~14.74,P=0.36)、切除肿瘤大小(SMD=–0.40,95%CI:–0.87~0.08,P=0.10)、淋巴结清扫(MD=–0.49,95%CI:1.80~0.82,P=0.46)、随诊2年肿瘤复发(OR=1.15,95%CI:0.38~3.50,P=0.81)等指标NOSE组与LAP组比较差异均无统计学意义;术后肛门首次排气时间(SMD=–0.62,95%CI:–0.82~–0.42,P<0.001)及术后恢复进食时间(SMD=–0.60,95%CI:–1.15~–0.05,P=0.03)NOSE组均较LAP组更早;术后疼痛指数(MD=–1.49,95%CI:–1.97~–1.01,P<0.001)NOSE组较LAP组明显较低;且NOSE组具有更好的美容效果(MD=1.37,95%CI:0.59~2.14,P=0.0005)。结论:腹腔镜辅助腹部无辅助切口结直肠癌切除可显著减少患者切口并发症的发生,并可减轻患者疼痛,加快术后恢复,具有更好的美容效果,是治疗结直肠癌安全、可行、有效的方法。Objective： To evaluate the safety） feasibility and effectiveness of laparoscopic-assisted resection of colorectal cancer without incision at abdomen vs the traditional laparoscopic resection. Methods： We retrieved literature published from August, 2005 to August, 2015 to compare laparoscopic-assisted resection for colorectal cancer without incision at abdomen with the traditional laparoscopic resection. The clinical indicators were extracted from literature met inclusion criteria. The RevMan 5.3 software with a Meta-analysis was used. Results： Seven literature with a total of 621 patients, including 262 in laparoscopic-assisted resection of colorectal cancer without auxiliary incision at abdomen group （NOSE group） and 359 in conventional laparoscopic colorectal resection group （LAP group）, were enrolled. The Meta~ analysis showed that the total complication rate in the NOSE group was significantly less than that in the LAP group （OR=0.31, 95% CI 0.18 to 0.53, P〈0.05）. Complications of incision in the NOSE group were less than those in the LAP group （OR= 0.15, 95% CI 0.05 to 0.40, P=0.0002）. Postoperative bleeding （OR=1.52, 95% CI 0.38 to 6.18, P=0.55）, intestinal obstruction （OR= 0.30, 95% CI 0.09 to 0.98, P=0.05）, anastomotic complications （OR=0.92, 95% CI 0.28 to 3.07, P=0.89）, and other related complications （OR=0.63, 95% CI 0.23 to 1.66, P=0.35） showed no significant difference between the 2 groups （P〉0.05）. Hospitalization （MD=-0.66, 95% CI -1.33 to 0.01, P=0.05）, duration of surgery （MD= 14.78, 95% CI -1.75 to 31.31, P=0.08）, bleeding amount （MD=-12.81, 95% CI-40.36 to 14.74, P=0.36）, the tumor size （SMD=-0.40, 95% CI-0.87 to 0.08, P=0.10）, the number of lymph node dissection （MD=-0.49, 95% CI 1.80 to 0.82, P=0.46）, and the recurrence of 2-year follow-up （OR= 1.15, 95% CI 0.38 to 3.50, P=0.81） were not statistically significant between the 2 groups. Time of gas passage （SMD=-0.62, 95% CI -0.82 to -0.42, P〈0.001） and time of regula

关 键 词：结直肠癌 腹腔镜 自然腔道 META分析 

分 类 号：R735.34[医药卫生—肿瘤]