腹腔镜与开腹中低位直肠癌根治术后并发症比较的Meta分析

Meta analysis of postoperative complications between laparoscopic resection and traditional openresection of mid-low rectal carcinoma

目的比较腹腔镜与开腹中低位直肠癌切除术后并发症发生情况。方法系统检索中国知网、万方数据库、外文生物医学期刊文献数据库（FMJS）、PubMed、EMBASE和TheCochraneLibrary等数据库中有关腹腔镜与开腹中低位直肠癌切除术对比的文献，检索截至2012年8月。由两名评价员独立筛选并提取数据资料．对复合标准的研究用RevMan5．0软件进行统计分析。结果13项临床对照研究纳入分析，病例总数2733例，其中腹腔镜组1368例，开腹组1365例。合并分析结果显示，腹腔镜组术后总并发症发生率（OR=O．76，95％CI：0．62～0．92，P〈0．叭）、术后肠梗阻发生率（OR=0．53，95％CI：0．35—0．80，P〈0．01）及术后切13并发症发生率（OR=0．43，95％CI：0．28N0．67，P〈0．01）均显著低于开腹组；两组吻合13瘘及术后大出血发生率的差异无统计学意义（均P〉0．05）。结论腹腔镜中低位直肠癌切除术后短期并发症发生率优于开腹手术；腹腔镜手术可安全地用于中低位直肠癌的治疗。

Objective To conduct a meta-analysis of postoperative complications between laparoscopic resection （Group LR） and traditional open resection （Group OR） of mid-low rectal carcinoma. Methods Meta analysis was performed by two reviewers, who independently selected and extracted data retrieved from literatures and papers published in China Knowledge Resource Integrated Database （CNKI）, Wangfang Data, Foreign Medical Journal Service （FMJS）, PubMed, EMBASE and The Cochrane before August 2012 on comparison between two groups. The statistical analysis for research of complex standard was conducted through Revman 5.0. Results Thirteen clinical case- control studies with a total of 2733 cases were enrolled for analysis, including 1368 cases in Group LR and 1365 in Group OR. The result showed that, compared with Group OR, Group LR had lower overall rate of postoperative complication （OR =0.76, 95%C,I： 0.62-0.92, P〈0.01 ）, lower rate of postoperative intestinal obstruction（OR=0.53, 95%（2/：0.35-0.80, P〈0.01）, lower rate of incision complications（OR= 0.43, 95% CI：0.28-0.67, P〈0.01）, similar incidence of anastomotic bleeding and fistula, and similar incidence of bleeding in abdominal cavity and pelvic cavity （all P〉0.05 ）. Conclusions The overall rate of postoperative complications of laparoscopie resection for mid-low rectal carcinoma is obviously lower than that of open resection. Laparoscope can be applied safely in the resection of mid-low rectal