摘要
目的:探讨腹腔镜的应用是否会对全直肠系膜切除术(TME)术后吻合口漏发生率造成影响.方法:全面检索中、英文献,收集腹腔镜全直肠系膜切除术(LTME)与开腹全直肠系膜切除术(OTME)术后吻合口漏发生率比较的随机对照试验(RCT)、临床对照试验和病例系列.由两名作者独立评价文献,采用RevMan5.0.2.0软件进行Meta分析.结果:共纳入3项个体RCT,2项个体病例对照研究和13项病例系列.纳入研究存在方法学异质性,根据纳入研究的方法学类型进行亚组分析,亚组内无统计学异质性,采用固定效应模型进行合并分析.LTME与OTME术后吻合口漏发生率差异无统计学意义(P=0.60),合并比值比(OR)及其95%可信区间(95%CI)为0.90(0.60,1.34).结论:腹腔镜的应用不会对TME吻合口漏发生率造成影响.然而由于是在缺乏足够数量的RCT的情况下,纳入部分分级为3b和4的非随机对照试验的Meta分析,使论证强度受到一定的限制,有待更多大样本高质量RCT结果的进一步验证.
AIM： To explore whether the application of laparoscopy to total mesoreetal excision increase the incidence of postoperative anastomotic leakage. METHODS： Literatures of randomized controlled trials （RCT）, controlled clinical trials and case series in Chinese and English relative to the incidence of postoperative anastomotic leakage of laparoscopic total mesorectal excision （LTME） versus open total mesorectal excision （OTME） for rectal cancer were searched for. Literatures were evaluated and data were screened by two authors independently and RevMan5.0.2.0 software was used for recta-analysis. RESULTS ： Three individual RCT, 2 individual case-control studies and 13 case-series were included. Considering the methodological heterogeneity of the included trials, we classified the samples by the methodologies employed in the trials. As no statistical heterogeneity of the methodologies used was seen in the subgroups, fixed effect model was used to analyze the overall effect. There was no statistical difference in the incidence of postoperative anastomotic leakage between the two groups （P = 0.60） and the pooled odds ratio （OR） was 0.90（95% confidence interval, 95% CI, 0. 60 to 1.34）. CONCLUSION： The application of laparoseopy to TME will not increase the incidence of postoperative anastomotic leakage. But the results of our study have some limitations due to nonrandomized controlled trials with grade 3b and 4 included in the study and the relatively small-sized RCT samples. More RCTs with a large sample size are needed to further confirm the results.
出处
《第四军医大学学报》
北大核心
2009年第7期632-635,共4页
Journal of the Fourth Military Medical University
