摘要
目的：诩介腹腔镜直肠癌根治术（LTME）的安全性和有效性。方法：收集1991～2015年公开友表的腹腔镜和开腹手术治疗直肠癌的中文和英文文献，对腹腔镜组和开腹组的术中术后恢复情况、术后并发症情况、手术死亡率及5年生存率进行Meta分析。结果：共筛选出符合纳入标准的研究7项1953例，其中腹腔镜组990例，开腹组963例。腹腔镜组、开腹组淋巴结清扫数目、术中切除标本长度、手术死亡率及5年无瘤生存率，差异无统计学意义（P〉0．05）。腹腔镜组手术时间明显长于开腹组（P〈0．05），术中出血量明显少于开腹组（P〈0.05），术后肠道功能恢复时间明显早于开腹组（P〈0．05），并发症发生率明显低于开腹组（P〈0．05），术后住院时间明显短于开腹组（P〈0．05）。结论：LTME具有术中出血少、术后恢复快及并发症发生率低等优点；但手术操作难度较大，手术时间长，需要一定的学习曲线。
Objective： To study security,validity of laparoscopic radical resection for rectal cancer. Methods： Clinical trials comparing laparoscopic total mesorectal excision（LTME） with open total mesorectal excision （OTME） for middle and low rectal cancer publishen from 1991 to 2015 were retrieved. A meta-analysis was conducted to evaluate operative time,blood loss, number of lymph nodes dissection,specimen length, post-operative hospital stay, post-operative complica-tions, death rate and 5 year survival rate between LTME group and OTME group. A fixed effect model or random effect model was established to collect the data. Results： Eleven RCTs on 1953 patients qualified for the meta-analysis,990being allocated to LTME and 963 to OTME. There was no significant difference between LTME and OTME for number of lymph nodes dissection, specimen length, death rate and 5 year survival rate. However,operative time was significantly longer in LTME than OTME （P〈0.05）. intraoperative bleeding was significantly less in LTME than OTME （P〈0.05）, postoperative intestinal function recovery time significantly earlier in LTME than OTME（P〈0.05）, the incidence of complications was significantly lower in LTME than OTME （P〈0.05）, postoperative hospitalization time significantly shorter in LTME than OTME（P〈0.05）. Conclusion： Laparoscopic radical resection of rectal cancer is safe and feasible, with less bleeding in operation, postoperative recovery and complication, but the difficulty of the operation is large, operation time is tong, need a learning curve.
出处
《中国现代普通外科进展》
CAS
2016年第10期780-785,共6页
Chinese Journal of Current Advances in General Surgery
