腹腔镜与传统开腹TME在治疗中低位直肠癌的META分析

META-Analysis of Laparoscopic Versus Open Total Mesorectal Excision for Middle and Low Rectal Cancer

目的:探讨腹腔镜行TME手术治疗中低位直肠癌的可行性。方法:检索2001年1月～2012年2月间发表的比较腹腔镜与经腹TME手术治疗中低位直肠癌的随机对照试验(RCT)及临床对照试验(CCT)论文,根据纳入排除标准纳入文献,提取临床指标,进行META分析。结果:最终有22项临床试验被纳入,两组患者的性别、年龄等基本特征均衡。两组腹腔出血(P=0.36)、吻合口漏(P=0.06)及肠梗阻(P=0.16)之间差异无统计学意义,腹腔镜组较传统开腹组总的并发症(P<0.0001)及切口感染发生率低(P=0.0006),手术时间长(P=0.001),术中出血量少(P<0.00001),术后肠道功能恢复时间早(P=0.0002),住院时间短(P<0.00001)。结论:LTME较OTME在中低位直肠癌手术中能够更安全的达到根治性切除的效果,而且在减少手术对患者的创伤方面具有优势。

Objective： To evaluate whether there are any differences between LTME and OTME,in middle and low rectal cancer.Methods： We searched bibliographic databases in order to identify relevant primary studies from January 2001 to February 2012.We included randomized controlled trials（RCT） and non-randomized concurrent control trials.After selected based on the inclusion and exclusion standards,we fetched the characteristics of included studies,and finish the META-analysis finally.Results： 22 studies were included into the META-analysis.The basic characteristics of the LTME group were similar to those of the OTME group.In comparison with the OTME group,there were no significant differences in the rate of saving anus,anastomotic leakage and intestinal obstruction.But,the rates of wound infection and total morbidity were less（P〈0.001）,the duration of surgery was longer（P〈0.0001）,the blood loss was less（P〈0.0001）,the time of intestinal function recovery was earlier（P〈0.0001）,the hospital stay was earlier（P〈0.0001） than the OTME group.Conclusion： The safety and efficacy of LTME is equal to OTME,and the postoperative recovery is earlier than the OTME.