腹腔镜全直肠系膜切除术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

目的系统评价腹腔镜全直肠系膜切除术（TME）治疗中低位直肠癌的临床疗效和安全性。方法检索1991--2012年公开发表的针对腹腔镜TME和开腹TME治疗中低位直肠癌疗效比较的随机对照研究，使用RevMan5．1软件对两种术式的疗效进行Meta分析。结果8篇文献被纳人分析，样本量共计863例中低位直肠癌患者，其中腹腔镜TME组428例，开腹TME组435例。合并分析结果显示，与开腹TME相比，腹腔镜TME可明显减少术中出血量（P〈0．01），缩短术后肠道功能恢复时间（P〈0．01）及住院时间（P〈0．05），降低术后出血（P〈0．05）及切口感染（P〈0．01）的发生率；而在手术时间、淋巴结清扫数目、术后吻合口瘘、肠梗阻及盆腔脓肿发生率方面。两种术式的差异无统计学意义（均P〉0．05）。结论腹腔镜TME能够达到与开腹TME相当的术中淋巴结清扫效果，而且能促进患者术后康复，降低术后切口感染和术后出血的发生率。

Objective To evaluate the efficacy of laparoscOpic total mesorectal excision （laparoscopic TME） versus open total mesoreetal excision （open TME） in the treatment of middle and low rectal cancer using meta-analysis. Method From 1991 to 2012, the Chinese and English articles of randomized controlled trails （RTCs） about laparoscopic TME versus open TME in the treatment of middle and low rectal cancer were collected, and a meta-analysis was performed with RevMan 5.1 software. Results Eight RCTs including 863 patients with middle and low rectal cancer （428 cases in laparoseopic TME group, 435 cases in open TME group） were enrolled in the meta-analysis. Laparoseopic TME was associated with significantly less intraoperative blood loss（P〈0.01 ）, earlier to pass first flatus（P〈0.01 ）, shorter hospital stay（P〈0.05）, less postoperative incision infections （P〈0.01） and postoperative bleeding （P〈0.05） compared to open TME. There were no significant differences between laparoscopic TME and open TME groups in operative time, number of reseeted lymph nodes, anastomotic leak, ileus and pelvic abscess （all P〉0.05）. Conclusions As compared to open TME, laparoscopic TME has similar efficacy in terms of lymph nodes harvest, and it can promote postoperative recovery, and reduce incision infection and postoperative bleeding.