手辅助腹腔镜与标准腹腔镜右半结肠切除术疗效比较的meta分析

Comparison of clinical outcomes between hand assisted laparoscopic and standard laparoscopic right hemicolectomy:a meta-analysis

目的评价手辅助腹腔镜右半结肠切除术(HALC)与标准腹腔镜右半结肠切除术(SLC)的临床疗效。方法采用计算机检索万方、CNKI、维普、CBM、Pub Med、Embase、Cochrane Central Register of Controlled Trials等数据库,按照纳入和排除标准筛选文献,并使用Cochrane风险偏倚评估工具对纳入的随机对照试验进行质量评价,使用纽卡斯尔-渥太华量表对非随机对照研究进行评价,并采用Rev Man 5.3进行统计学分析。结果最终纳入9篇文献共976例患者,其中HALC组480例,SLC组496例。meta分析结果显示,与SLC组比较,HALC组的手术时间更短(P<0.05),但其切口长度及住院时间均更长(P<0.05)。2组在中转率、肠功能恢复时间、进食时间、住院期间再手术率、术后并发症和淋巴结清扫数目方面比较差异均无统计学意义(P>0.05)。对于远期随访结果,2组的3年生存率为90%左右,5年生存率为80%左右,在复发率和死亡率方面比较差异均无统计学意义(P>0.05)。结论 HALC与SLC均能取得较好的微创效果及达到肿瘤根治性,HALC主要在手术时间方面优于SLC,而SLC主要在切口长度和住院时间方面优于HALC,因此,HALC可以作为右半结肠切除术微创方式的一个选择。

Objective To assess clinical outcomes of hand assisted laparoscopic right hemicolectomy （HALC） and standard laparoscopic right hemicolectomy （SLC）. Methods The databases of Wanfang, CNKI, VIP, CBM, PubMed, Embase, and Cochrane Central Register of Controlled Trials were electronically searched. The relevant literatures were selected according to the inclusion and exclusion criteria. The Cochrane collaboration tool for assessing risk of bias was used to assess the quality of randomized controlled trials and the Newcastle-Ottawa Scale was used to assess non- randomized comparative studies. Meta-analysis was performed by using RevMan 5.3 software. Results A total of 9 studies were included and involved 976 patients （480 patients in the HALC group and 496 patients in the SLC group）. The results of meta-analysis showed that the HALC group was favor of shorter operative time as compared with the SLC group （P〈0.05）, but the length of incision and hospital stay were longer in the HALC group （P〈0.05）. There were no statistically significant differences between these two groups regarding as the conversion rate, time to return of bowel function, feeding time, reoperative rate during hospitalization, postoperative complications rate, and harvested lymph node number （P〉0.05）. As for the follow-up results, the 3-year survival rate was about 90%, and 5-year survival rate was about 80%, and there were no statistical differences in terms of recurrence rate and mortality between the HALC group and the SLC group （P〉0.05）. Conclusions Both HALC and SLC could achieve satisfactory minimal invasive outcomes and oncologic radical effects, and HALC has an advantage of shorter operative time, yet length of incision and hospital stay are longer than SLC. Therefore, HALC could be considered as an alternative to minimal invasive right hemicolectomy.