摘要
目的评价腹腔镜治疗直肠癌的效果和预后。方法检索"Pub Med""Embase""Cochrane Library"等数据库2009年1月至2014年6月发表的腹腔镜治疗直肠癌的相关文献,提取有关临床效果和预后,对符合质量标准的随机对照试验进行Meta分析。结果共纳入文献10篇,病例总数为2097例,其中行腹腔镜手术1056例,行传统开腹手术1041例。与传统开腹手术治疗直肠癌相比,腹腔镜手术术中出血量减少(WMD=-123.12,95%CI-197.04^-67.42,P<0.0001)、术后住院时间缩短(WMD=-3.12,95%CI-3.49^-2.75,P<0.00001)、术后并发症发生率降低(OR=0.45,95%CI 0.27~0.76,P=0.0003),但手术时间显著增加(WMD=47.36,95%CI 34.55~60.32,P<0.0001)。腹腔镜手术与开腹手术淋巴结清扫数目(WMD=-0.70,95%CI-1.70~0.20,P=0.560)、环周切缘阳性率(OR=0.45,95%CI 0.27~0.76,P=0.265)和术后5年存活率(OR=0.45,95%CI 0.27~0.76,P=0.067)比较,差异无统计学意义。结论腹腔镜治疗直肠癌术中出血量少、术后住院时间短,并发症发生率低,淋巴结清扫数目、环周切缘阳性率和术后的存活率与传统开腹手术无明显差别,可作为治疗直肠癌的常规术式。
Objective To evaluate effects and outcomes of laparoscopic operation for rectal cancer.Methods Searches were performed for randomized controlled trials about laparoscopic treatment rectal cancer among electronic databases（ Pub Med,Embase,Cochrane Library） from Jan. 2009 to Jun. 2014. The clinical effects and outcomes were extracted,and meta-analysis was conducted on eligible randomized controlled trial. Results Altogether 10 clinical controlled studies were finally included. The total number of patients was 1056 patients received Laparoscopic resection and 1041 received open resection. Compared with open resection,the blood loss（ WMD =- 123. 12,95% CI- 197. 04-- 67. 42,P 〈0. 0001）,length of hospital stays（ WMD =- 3. 12,95% CI- 3. 49-- 2. 75,P 〈0. 00001） and rate of postoperative complications（ OR = 0. 45,95% CI 0. 27-0. 76,P = 0. 0003） were lower in LR,but the operative time was increased（ WMD = 47. 36,95% CI 34. 55-60. 32,P 〈0. 0001）. There were no significant differences in harvested lymph nodes（ WMD =- 0. 70,95% CI- 1. 70-0. 20,P = 0. 560）,positive rate of circumferential resection margin（ OR = 0. 45,95% CI 0. 27-0. 76,P = 0. 265） and 5-year overall survival rate（ OR =0. 45,95% CI 0. 27-0. 76,P = 0. 067） between Laparoscopic resection and OR. Conclusion Laparoscopic operation has less blood loss,shorter length of hospital stays and lower postoperative complications,while there were no significant differences from traditional laparotomy in number of dissected lymph node,positive rate of circumferential resection margin and 5-year overall survival rate,and can be used as a routine surgery approach for treatment of rectal cancer.
出处
《医学综述》
2016年第6期1180-1185,共6页
Medical Recapitulate
关键词
直肠癌
腹腔镜
预后
META分析
Rectal cancer
Laparoscopy
Prognosis
Meta-analysis
