腹腔镜手术与开腹手术治疗结直肠癌临床效果比较的Meta分析

Comparison between Effects of Laparoscopy and Open Surgery on Colorectal Cancer:A Meta-analysis

目的比较腹腔镜手术(LS)与开腹手术(OS)治疗结直肠癌的临床效果。方法检索1991年1月—2010年7月公开发表的LS与OS治疗结直肠癌的随机对照试验(RCT)文献,根据入选标准筛选文献,提取有关临床效果指标进行Meta分析。结果按照筛选标准,共有14篇RCT共计5 478例结直肠癌患者纳入分析。LS组与OS组患者基本特征均衡。LS组术中出血量较OS组减少125 m l(P<0.001),手术时间延长42 m in(P<0.001),肿瘤直径、淋巴结检出数量、纵向切缘阳性率和环周切缘阳性率两组差异均无统计学意义(P>0.05);LS组术后并发症切口感染、麻痹性肠梗阻的发生率以及围术期病死率均较OS组明显降低(P<0.001),其他并发症间差异均无统计学意义(P>0.05)。远期疗效如3年生存率、5年生存率、局部复发和远处转移两组差异均无统计学意义(P>0.05),但LS组穿刺孔肿瘤种植较OS组切口肿瘤种植的发生率明显增高(P=0.04)。结论 LS创伤小,可安全地根治结直肠癌,远期效果与OS无差异。

Objective To compare the clinical effects of laparoscopic surgery（LS） and open surgery（OS） on colorectal cancer.Methods Randomized controlled trial（RCT） reports on LS and OS for colorectal cancer published from January 1991 to 2010 were retrieved and relevant clinical effect indexes extracted,based on inclusion criteria,to perform Meta-analysis.Results A total of 14 RCT reports（5 478 colorectal cancer patients） were included in this study.The basic features of 2 groups were balanced.Blood loss of LS group was lower by 125 ml than that of OS group（P0.001）,operative time longer by 42 min（P0.001）,no significant difference was noted in tumor size,detection of lymph nodes,positive rate of longitudinal or circumferential resection margin between 2 groups.Incidence of such complications as postoperative infection and paralytic ileus,perioperative mortality were significantly lower in group LS than in group OS（P0.001）,but no difference in other complications.There was not significant difference in 3-year survival,5-year survival,local recurrence or distant metastasis,but incidence of puncture neoplasm seeding higher in LS group than in OS group（P=0.04）.Conclusion LS,with fewer operative wounds,can cure colorectal cancer safely and radically,not differing from OS in long-term effect.