腹腔镜肛门括约肌间超低位直肠癌根治术与开腹手术疗效的Meta分析

Meta-analysis of the efficacies of laparoscopic intersphincteric resection and laparotomy for ultra-low rectal cancer

目的 通过Meta分析探讨腹腔镜经括约肌间切除（ISR）与开腹ISR治疗超低位直肠癌的短期疗效.方法 系统检索PubMed、EMBase、Ovid、中国期刊全文数据库（CNKI）、万方医药期刊全文数据库中比较腹腔镜ISR与开腹ISR治疗超低位直肠癌所有病例对照试验,包括发表和未发表的资料及会议论文.由两位研究者独立进行方法学质量评价之后,采用RevMan5.2软件进行Meta分析.结果 共纳入5篇有关的病例对照研究,合计522例患者.Meta分析结果表明,术中出血量[均数差（MD）=-65.42,95％ CI为-93.45～-37.38,Z=4.57,P＜0.000 01]、排气时间（MD=-0.96,95％ CI为-1.45 ～-0.47,Z=3.83,P=0.000 1）及住院时间（MD=-1.69,95％CI为-2.19～-1.19,Z=6.63,P＜O.000 01）,腹腔镜组优于开腹组,差异有统计学意义;手术时间（MD =6.61,95％ CI为-21.29～34.51,Z=0.46,P=0.64）、环周切缘阳性率（OR =1.01,95％ CI为0.37 ～ 2.80,Z=0.02,P=0.98）及术后并发症发生率（OR=0.73,95％CI为0.45 ～1.20,Z=1.23,P=0.22）差异无统计学意义;而开腹组在淋巴结清扫数目方面,略优于腹腔镜组（MD=-1.16,95％ CI为-2.14～-0.18,Z=2.31,P=0.02）,差异有统计学意义.结论 腹腔镜ISR手术治疗超低位直肠癌在术后短期疗效方面优于开腹手术.

Objective To compare the short-term efficacies of laparoscopic intersphincteric resection （ISR） and laparotomy for ultra-low rectal cancers by Meta-analysis.Methods We searched case-control trials that compared clinical outcomes of laparoscopic ISR and laparotomy from PubMed, EMBase, Ovid, CNKI and Wanfang database.Relevant published and unpublished data and conference papers were also retrieved.Two reviewers independently assessed the qualities of the included studies.Meta-analysis was performed by using of RevMan5.2 software.Results A total of 5 trials with 552 cases were included.The results of Meta-analysis showed that in terms of blood loss of the operation [mean difference （MD） =-65.42, 95% CI：-93.45--37.38, Z=4.57, P〈0.000 01], flatus passage time （MD=-0.96, 95%CI：-1.45--0.47, Z=3.83, P=0.000 1） and hospital stays （MD=-1.69,95%CI：-2.19--1.19, Z=6.63, P〈0.00001）,laparoscopic ISR were significantly superior than those of laparotomy, with significant differences.In terms of operation time （MD =6.61,95 % CI：-21.29-34.51, Z =0.46, P =0.64）, the positive rate of circumferential resection margin （OR =1.01, 95% CI： 0.37-2.80, Z =0.02, P =0.98） and postoperative morbidity （0R=0.73, 95% CI： 0.45-1.20, Z =1.23, P =0.22）, there were no significant differences in the two groups.However, laparotomy may clean more numbers of lymph nodes than those of laparoscopic ISR （MD =-1.16, 95%CI：-2.14--0.18, Z =2.31, P =0.02）, with significant difference.Conclusion The shortterm efficacy of laparoscopic ISR is superior than that of laparotomy in the treatment of ultra-low rectal cancer.