经肛提肌外腹会阴联合切除术与传统腹会阴联合切除术在低位直肠癌根治术中优越性比较的Meta分析

Advantage of extralevator abdominoperineal excision comparing to the conventional abdominoperineal excision for low rectal cancer:a Meta-analysis

目的:经肛提肌外腹会阴联合切除术(extralevator abdominoperineal excision,ELAPE)治疗低位直肠癌可提高手术安全性和生存率仍存在争议。用Meta分析比较ELAPE与传统腹会阴联合切除术(conventional abdominoperineal excision,APE)在低位直肠癌根治术中的优越性。方法:在线检索Pub Med,Embase和Cochrane Library以及中国生物医学文献数据库、中国期刊全文数据库和万方数字化期刊全文数据库中ELAPE组与APE组术中穿孔率,切缘阳性率,局部复发率,术后并发症等相关的病例对照研究或队列研究,采用Ren Man 5.2软件对入选研究进行Meta分析。结果:共纳入10篇文献,ELAPE组术中穿孔率(MD=0.54,95%CI:0.31~1.39,P=0.03)和局部复发率(MD=0.30,95%CI:0.21~0.42,P<0.001)明显低于APE组。两组切缘阳性率(P=0.07)的差异无统计学意义。结论:通过会阴缺口的修补和个体化治疗可以改善ELAPE组术后生活质量。ELAPE术式治疗低位直肠癌较APE术式有一定优势,但应注重个体化治疗。同时建议开展大样本、多中心、中长期的随机对照研究,明确该术式的肿瘤学效果。

Objective：Whether extralevator abdominoperineal excision（ELAPE）improves survival and safety remains controversial.Systematic review of all comparative studies to define the superiority of ELAPE to conventional abdominoperineal excision（APE）.Methods：Corresponding data,with case-control studies or cohorts regarding intraoperative perforation rate,the local recurrence rate and postoperative complications in the ELAPE group and the APE group,were retrieved from PubM ed,Embase,the Cochrane Library,Chinese Biomedical Literature（CMB）,VIP,China National Knowledge Infrastructure（CNKI）,and Wanfang Database.Meta-analysis was performed by using Ren Man 5.2.Results：A total of 10 articles were included.Intraperative perforation rate（MD=0.54,95%CI 0.31to 1.39,P=0.03）,local recurrence rate（MD=0.30,95%CI 0.21 to 0.42,P〈0.001）in the ELAPE group was significantly lower than that in the APE group.The difference in positive margin rate between the 2 groups was not statistically significant（P=0.07）.Conclusion：Through gap repair of episiotomy and individualized therapy can improve ELAPE postoperative quality of life.ELAPE shows certain advantages in treating lower rectal cancer comparing to APE,but it should pay attention to individualized treatment.More studies through large sample multi-center,medium and long term randomized design are necessary to determine the effect of surgery on tumor.