腹腔镜与开腹全系膜切除术治疗直肠癌临床疗效的Meta分析  

Laparoscopic versus open total mesorectal excision for rectal cancer:a Meta-analysis

作　　者：叶家友 李远强[1] 马松鹤[1] 陈爱军[1] YE Jiayou LI Yuanqiang MA Songhe et al.(Department of Gastrointestinal Surgery, the First Clinical Medical College of Three Gorges University, Yichang Central People＇s Hospital ,Hubei 443000, Chin)

机构地区：[1]三峡大学第一临床医学院(宜昌市中心人民医院),湖北宜昌443000

出　　处：《临床外科杂志》2017年第2期124-127,共4页Journal of Clinical Surgery

摘　　要：目的比较腹腔镜与开腹全直肠系膜切除术治疗直肠癌的临床疗效。方法计算机检索PubMed、EMBASE、Cochrane Library、CNKI、万方、维普等数据库2010年9月1日至2015年9月1日期间公开发表的腹腔镜与开腹全直肠系膜切除术的随机对照研究,2位评价者按纳入排除标准独立完成文献筛选,交叉审核,提取相关结局指标数据,应用RenMan 5.1软件进行Meta分析。结果最终纳入10篇对照研究,总病例数2820例,腹腔镜全直肠系膜切除术(1aparoscopic total mesorectal excision,LTME)组1595例,开腹全直肠系膜切除术(open total mesorectal excision,OTME)组1225例。围手术期相关指标:LTME组手术时间较OTME组长30.34 ml,LTME组术中出血量较OTME组少78.26 ml,LTME组术后肛门首次通气时间平均短1.13天,LTME组术后平均住院时间平均短2.60天,同时LTME组术后切口感染发生率更低。而LTME组与OTME组淋巴结清扫数,环切缘阳性例数,吻合口瘘、肠梗阻发生率比较,差异均无统计学意义。预后相关研究指标:LTME组与OTME组3年局部复发、3年总生存率、3年无病生存率(DFS)、5年OS、5年DFS比较,差异均无统计学意义。结论LTME治疗直肠癌短期疗效优势明显,术中出血少,肛门通气时间早,术后平均住院时间短,切口感染发生率低。二者远期疗效比较LTME组不亚于OTME组。Objective To evaluate the clinical outcomes of laparoscopic versus open surgery for rectal cancer. Methods A search of Pubmed, EMBASE, Cochrane library, CNKI, Wangfang and VIP da- tabase was undertaken and studies published from Sep. 2010 to Sep. 2015 were identified. Two evaluators independently reviewed articles, extracted data and cross-checked the quality of included studies according to Cochrane Handbook. Meta-analyses were conducted by using RevManS. 1 software. Results Ten stud- ies met the final inclusion criteria. A total of 2820 patients undergoing rectal surgery were examined, inclu- ding 1595 cases in the laparoscopic total mesorectal excision （LTME）group and 1225 cases in the open to- tal mesorectal excision（OTME） group. Meta-analysis showed that the amount of operation time in the LT- ME group was longer than the OTME group（ MD = 30.34,95% C1：21.61 to 39.0, P 〈 0. 00001 ） ; the a- mount of blood loss during operation in the LTME group was smaller than the OTME group （MI） = - 78.26,95%CI： -116.20 to -40.32,P〈0.0001,）; the time of first flatus（MD = -1.13,P 〈 0. 00001,95% CI ： - 1.49 to - 0.78 ） and postoperative hospital stay （ MD = - 2.6, P 〈 0. 00001, 95 % CI ： - 3.5 to - 1.7） in the LTME group were shorter than the OTME group; the morbidity of postoperative wound infection in the LTME group was lower than the OTME group（ RR = 0.28, P 〈 0. 00001,95% CI ： 0.19 to 0.43 ）. There were no significant differences in the number of harvested lymph nodes, the positive rate of circumferential margin,the rate of anastomotic leak or obstruction between the two groups. In the long-term effects, there were no significant differences in 3-year postoperative local recurrence, 3-year o- verall survival and disease-free survival, and 5-year survival and disease free survival between the groups. Conclusion This study suggests that the long-term outcomes of LTME appear to be equivalent to the open surgery for treatment of rectal cancer. Besides,it has more favorable sho

关 键 词：直肠癌 腹腔镜 开腹手术 疗效 META分析 

分 类 号：R735.37[医药卫生—肿瘤]