摘要
目的:通过meta分析比较腹腔镜与传统开腹全直肠系膜切除(total mesorectal excision,TME)保肛手术治疗中低位直肠癌长期结果的差异。方法:检索Pub Med、MEDLINE、Cochrane Library、中国生物医学文献服务系统(CBM)、万方数据库、中国知网数据库、维普等电子数据库。收集比较腹腔镜与开腹中低位直肠癌TME保肛手术的随机对照试验(randomized controlled trial,RCT)、非随机对照试验(non-randomized controlled trial,non-RCT)。统计分析使用Revman 5.2软件。结果:共将6篇文献纳入meta分析,1篇RCT,5篇non-RCT,共882例患者,其中腹腔镜组477例,开腹组405例。两组切缘阳性比值比(odds ratio,OR)=1.67,95%可信区间(confidence interval,CI)=(0.91,3.05)(P=0.10);吻合口瘘OR=1.03,95%CI=(0.57,1.87)(P=0.91);局部复发OR=0.71,95%CI=(0.16,3.15)(P=0.65);总生存率风险比(hazard ratio,HR)=0.98,95%CI=(0.90,1.07)(P=0.67);无病生存率HR=1.02,95%CI=(0.82,1.28)(P=0.85)。两组差异均无统计学意义。结论:腹腔镜中低位直肠癌TME保肛手术具有与传统开腹手术相似的长期结果。但目前仍需设计RCT评估患者术后长期肿瘤学结果及术后生活质量。
Objective：The aim of this study was to compare the long-term results of laparoscopic and conventional open total mesorectal excision （TME） with sphincter-preservation for mid and low rectal cancer using meta-analysis. Methods：PubMed, the Ovid MEDLINE, the Cochrane Library, SinoMed CBM, Wanfang data, CNKI and VIP were searched. Randomized controlled trial （RCT） or non-randomized controlled trial （non-RCT） comparing laparoscopic versus open TME with sphincter-preservation for mid and low rectal cancer were collected. Revman 5.2 software was used to complete statistic analysis. Results ： Six studies, one was RCT and 5 non-RCTs, including 882 patients （laparoscopic group had 477 cases and open group had 405 cases） ,were enrolled in the meta-analysis. No signif- icant differences between the two groups were found in positive circumferential margin [ OR = 1.67,95% CI = （0.91,3.05） , P = 0.10 ], anastomotic fistula [ OR = 1.03,95% CI = （0.57,1.87）, P = 0.91 ], locoregional recurrence [ OR = 0.71,95 % CI = （0. 16, 3.15 ） ,P = 0.65 ], overall survival [ HR = 0.98,95 % CI = （0.90,1.07）, P = 0.67 ] and disease-free survival [ HR = 1.02,95% CI = （ 0.82,1.28 ）, P = 0.85 ]. Conclusions： The long-term resuhs of laparoscopic TME with sphincter-preservation for mid and low rectal cancer is the same as the conventional laparotomy＇ s. Nevertheless, RCTs should be designed to evaluate the long-term oncologic out- comes and the qualities of life.
出处
《腹腔镜外科杂志》
2014年第11期829-834,共6页
Journal of Laparoscopic Surgery
