摘要
目的:评价直肠癌侧方淋巴结清扫术(lateral lymph node dissection, LLND)在直肠癌根治术中的价值.方法:检索国内外公开发表的有关直肠癌LLND的中文和英文文献,最终符合入选标准的文献共15篇,包含4 858例患者,其中LLND组2 401例,NLLND组(非LLND)2 457例.评价指标包括5年生存率、复发率、围手术期情况以及术后泌尿系统功能和性功能情况等.结果: NLLND组的手术时间较LLND组明显缩短[加权均数差(weighted mean difference, WMD)为109 min,95% 可信区间(confidence interval,CI)为90~129,P<0.000 01];LLND组的术中失血量大于NLLND组,但差异无统计学意义(WMD为429 mL,95%CI为325~854,P=0.05);LLND组的围手术期并发症发生率明显高于NLLND组[比值比(odds ratio,OR)为1.57,95%CI为1.06~2.33,P=0.02].LLND组与NLLND组的手术后5年生存率差异无统计学意义(OR为0.94,95%CI为0.78~1.12,P=0.48);LLND组与NLLND组总的手术后复发率差异无统计学意义(OR为0.92,95%CI为0.70~1.22,P=0.57).此外,NLLND组发生泌尿系统功能障碍的可能性低于LLND组(OR为5.12,95%CI为2.15~12.19,P=0.000 2);个别研究报道NLLND组男性患者的性功能障碍发生率低于LLND组(P<0.05).结论:Meta分析结果显示,LLND组在降低术后复发率和延长生存期方面未显示出明显优势,但LLND组的围手术期并发症发生率有所增加、手术时间延长、手术出血量增加,术后性功能和泌尿系统功能障碍的发生率也均有所增加.
Objective:To assess the value of lateral lymph node dissection (LLND) in the radical surgery of rectal cancer. Methods:The published Chinese and English literature about LLND was retrieved. Totally 15 literature fitted the selection criteria, which included 4 858 patients. Among them 2 401 patients were in LLND group and 2 457 patients in non-LLND (NLLND) group. The evaluation parameters included 5-year survival rate, recurrence rate, peri-operative outcomes, postoperative urinary and sexual fimctions. Results:The operating time was significantly shorter in the NLLND group than that in the LLND group [ weighted mean difference (WMD) = 109 min, 95% confidence interval(CI) : 90-129; P 〈0. 000 011- Intra-operative blood loss was greater in the LLND group than that in the NLLND group but the difference was not significant ( WMD = 429 mL, 95% CI: 325-854 ;P = 0.05 ). The frequency of peri-operative morbidity (OR: 1.57 95% CI: 1.06-2.33 ;P = 0.02) was significantly higher in the LLND groups compared with the NLLND group. There were no significant differences in 5-year survival rate ( OR: 0. 94, 95% CI: 0. 78-1. 12;P =0.48), and recurrence rate (OR: 0. 92, 95% CI: 0. 70-1.22;P = 0.57) between the two groups. Data from individual studies( three studies) showed that the frequency of male urinary dysfunction (OR: 5.12, 95 % CI: 2.15-12.19; P = 0. 000 2 ) and sexual dysfunction (P 〈 0.05 ) were greatly lower in the NLLND group than those in the LLND group, Conclusion:Meta analysis showed that LLND did not have specific advantage in decreasing postoperative recurrence and prolonging survival time, LLND was associated with prolonged operation time, in- creased blood loss, and elevated incidence of peri-operative complications and urinary, and sexual dysfunction.
出处
《肿瘤》
CAS
CSCD
北大核心
2010年第8期676-681,共6页
Tumor
基金
江西省教育厅科学技术研究项目(编号:GJJ08120)