结直肠癌患者经腹腔镜手术后短期疗效和安全性的荟萃分析

Meta-analysis of short-term efficacy and safety after laparoscopic resection for colorectal cancer

目的评价结直肠癌腹腔镜手术的短期疗效和安全性。方法检索2005年12月前已公开发表的比较结直肠癌腹腔镜手术与开腹手术短期临床效应差异的前瞻性随机对照试验(randomized controlled trials,RCT)。按纳入和排除标准筛选后进行质量评分,提取短期临床效应指标,进行荟萃分析。结果 9项 RCT 纳入荟萃分析,平均质量评分(7.6±0.6)分。腹腔镜手术组与开腹手术组患者基本特征均衡。较之开腹手术组,腹腔镜手术组切口长度减少12 cm[95% CI(-13.51～-10.49),P<0.01],出血量较开腹手术组减少约75 ml[95%CI(-86.06～-62.99),P<0.01],但是手术时间延长42 min[95% CI(32.18～52.50),P<0.01]。标本长度、切缘阳性率及淋巴结检出数量等,两组差异均无统计学意义。两组患者术中并发症、术后总体并发症和具体并发症发生率差异无统计学意义。腹腔镜手术组患者术后第一天疼痛更轻[加权均数差 WMD=-0.80,95%CI(-1.26～-0.34),P<0.01],肠外镇痛药使用量更少[标准化均数差 SMD=-0.31,95%CI(-0.42～-0.21),P<0.01],同时其术后排气时间、肠蠕动恢复时间、饮食恢复时间及出院时间均早于开腹手术组患者(P<0.05)。结论腹腔镜手术可安全地根治结直肠癌,对患者的创伤亦明显减少。

Objective To evaluate the short-term curative effects and safety of laparoscopic resection （LR） in treatment of colorectal cancer. Methods The databases PubMed, Embase, CCTR, and CBMdisc were retrieved and 15 medical journals published in different countries were retrieved manually to search the literatures related to randomized controlled trials （RCTs） on the comparison between the effects and safety of LR and open resection （OR） in treatment of colorectal cancer that were published before the end of 2005. After selected based on the inclusion and exclusion standards, the valid literature were appraised by 2 reviewers independently. Results Nine articles, with a mean quality score of 7. 6 ± 0. 6 were included into the meta-analysis. The baseline characteristics of the LR group were similar to those of the OR group. In comparison with the OR group, the incision length of the LR group was shorter by 12 cm [95% CI （ - 13.51, - 10.49）, P 〈0.01], blood loss was less by 75 ml [95% CI （ -86.06, -62. 99）, P 〈0. 01 ], intensity of pain in the first day after operation was lower [ weight mean deviation = -0. 80, 95% CI （ - 1.26, - 0. 34）, P 〈 0. 01 ] , parenteral narcotic requirement was lower [ standard mean deviation = - 0. 31, 95% CI （ - 0. 42, - 0. 21 ）, P 〈 0. 01 ] , and average times before the postoperative first flatus, first bowel movement, and diet resumption, and discharge were all shorter （ all P 〈 0. 05 ） ; however, the operation time was longer by 42 min[ 95% CI （ 32. 18, 52. 50 ）, P 〈 0. 01 ]. There were no significant differences in the length of resected specimen, positive rate of resection margin, number of retrieved lymph nodes, and morbidity rates of intra-operative and post-operative complications. Conclusion With faster recovery and less pain compared with OR, LR is safe and effective in the treatment of colorectal cancer.