全直肠系膜切除术与其联合侧方淋巴结清扫治疗中、低位直肠癌疗效比较的Meta分析  

Meta analysis of the efficacy of total mesorectal resection and total mesorectal resection combined with lateral lymph node dissection in the treatment of middle and low rectal cancer

作　　者：路松名 张宏[1] 冯勇[2] LU Song-ming;ZHANG Hong;FENG Yong(Department of Colorectal Cancer Surgery,Shengjing Hospital of China Medical University,Shenyang 110004,China;Department of Minimally Invasive Surgery for Colorectum and Hernia,Shengjing Hospital of China Medical University)

机构地区：[1]中国医科大学附属盛京医院结直肠肿瘤外科,辽宁沈阳110004 [2]中国医科大学附属盛京医院结直肠疝微创外科

出　　处：《腹腔镜外科杂志》2020年第8期582-588,共7页Journal of Laparoscopic Surgery

基　　金：辽宁省自然科学基金资助项目(20170540997)。

摘　　要：目的:比较单纯全直肠系膜切除术(TME)与TME联合侧方淋巴结清扫(LLND)在术后并发症及预后方面的优劣。方法:检索2010年1月至2020年5月中文、英文数据库中涉及TME与TME+LLND比较的文献,采用RevMan 5.3进行meta分析。结果:总计纳入12篇文献、3769例中低位直肠癌患者,相较单纯TME组,TME+LLND组具有更高的Clavien-Dindo分级≥3的并发症发生率[OR=1.50,95%CI(1.06,2.13),P=0.02],更低的术后局部复发率[OR=0.47,95%CI(0.34,0.65),P=0.00001];两组泌尿功能[OR=1.10,95%CI(0.62,1.95),P=0.74]、Clavien-Dindo分级≥1的并发症[OR=1.40,95%CI(0.95,2.06),P=0.09]、总生存率[HR=1.23,95%CI(0.94,1.61),P=0.13]、无复发生存率[HR=1.05,95%CI(0.89,1.26),P=0.55]差异无统计学意义。结论:TME+LLND较TME在局部复发方面存在显著优势,也更容易发生Clavien-Dindo分级≥3的并发症。Objective:To compare the advantages and disadvantages of total mesorectal excision(TME)and TME combined with lateral lymph node dissection(LLND)in postoperative complications and prognosis.Methods:The literatures related to comparison of TME and TME+LLND were searched in Chinese and English databases from Jan.2010 to May 2020,and RevMan 5.3 was used for meta-analysis.Results:A total of 12 literatures and 3769 patients with middle and low rectal cancer were included in this study.Compared with TME alone,TME+LLND group had a higher incidence of complications with Clavien-Dindo grade≥3[OR=1.50,95%CI(1.06,2.13),P=0.02]and a lower incidence of local recurrence[OR=0.47,95%CI(0.34,0.65),P=0.00001].There was no significant difference between the two groups in urinary function[OR=1.10,95%CI(0.62,1.95),P=0.74],complications with Clavien-Dindo grade≥1[OR=1.40,95%CI(0.95,2.06),P=0.09],overall survival[HR=1.23,95%CI(0.94,1.61),P=0.13],recurrence-free survival[HR=1.05,95%CI(0.89,1.26),P=0.55].Conclusions:TME+LLND has obvious advantages over TME in local recurrence,and is more likely to have complications with Clavien-Dindo grade≥3.

关 键 词：直肠肿瘤 全直肠系膜切除术 侧方淋巴结清扫 META分析 

分 类 号：R735.37[医药卫生—肿瘤]