腹腔镜手术与开腹手术治疗直肠癌短期临床疗效的meta分析

Comparison between laparoscopic surgery and open surgery for rectal cancer: a meta-analysis of short-term clinical efficacy

目的:通过meta分析评估比较腹腔镜手术(laparoscopic surgery,LS)与开腹手术(open surgery,OS)治疗直肠癌的短期临床疗效。方法:在Pub Med、Cochrane library等数据库中检索2004年1月至2014年1月发表的有关LS与OS治疗直肠癌短期疗效的随机对照试验(randomized controlled trials,RCTs)文献,使用Rev Man 5.2对数据进行meta分析。结果:共有8篇RCT文献、1 518例病例纳入此次研究,其中腹腔镜组663例,开腹组855例。Meta分析结果显示,与开腹组相比,腹腔镜组手术时间较长[MD=26.41,95%CI=(15.26,37.56),P<0.00001],淋巴结清扫数量稍少,但差异无统计学意义[MD=-0.92,95%CI=(-2.39,0.55),P=0.22],出血量更少[MD=-54.22,95%CI=(-73.71,-34.74),P<0.00001],肠道恢复时间[MD=-1.19,95%CI=(-1.70,-0.68),P<0.00001]、第一次进食时间[MD=-0.95,95%CI=(-1.56,-0.33),P=0.002]、住院时间[MD=-3.62,95%CI=(-4.96,-2.28),P<0.00001]均较短,并发症发生率也较低[RR=0.76,95%CI=(0.63,0.91),P=0.003],其余指标均较好。结论:LS治疗直肠肿瘤短期疗效优于OS,手术安全、可行。

Objective： To compare the short-term efficacy of laparoscopic surgery and open surgery for rectal cancer on the basis of meta analysis. Methods： The literature of randomized controlled trials（ RCTs） comparing the short-term efficacy of laparoscopic and open surgery for rectal cancer was searched in Pub Med and the Cochrane library from Jan. 2004 to Jan. 2014,and the Rev Man 5. 2software was used to analyze the data. Results： Eight RCTs were included in our study,with 663 cases in laparoscopic surgery group and855 cases in open surgery group. The results showed that the laparoscopic surgery group was superior on the blood loss [MD =-54. 22,95% CI =（-73. 71,-34. 74）,P〈0. 00001],time to the first bowel movement [MD =-1. 19,95% CI =（-1. 70,-0. 68）,P〈0. 00001],the first food intake [MD =-0. 95,95% CI =（-1. 56,-0. 33）,P = 0. 002],length of postoperative hospital stay [MD =-3. 62,95% CI =（-4. 96,-2. 28）,P〈0. 00001]and the complications [RR = 0. 76,95% CI =（ 0. 63,0. 91）,P = 0. 003],whereas the laparoscopic group had longer surgery time [MD = 26. 41,95% CI =（ 15. 26,37. 56）,P〈0. 00001]. At the same time,there was no significant difference in the number of harvested lymph nodes [MD =-0. 92,95% CI =（-2. 39,0. 55）,P = 0. 22]. Conclusions： The laparoscopic surgery is safe and feasible,has a more promising short-term clinical efficacy than the open surgery for rectal cancer.