腹腔镜与开腹保肛手术治疗中低位直肠癌效果比较的Meta分析

Efficacy of laparoscopic versus open surgery with anal sphincter preservation for mid-low rectal cancer:a meta-analysis

目的系统评价腹腔镜与开腹保肛手术治疗中低位直肠癌的临床疗效。方法检索Pubmed、Embase、Cochrane lib ra ry、中国知网、万方数据库中关于比较腹腔镜与开腹保肛手术治疗中低位直肠癌的随机对照试验(RCT),检索时间截止2017年10月。采用Re VMan 5.3软件进行数据分析。结果最终纳入11篇RCT,共1 090例患者。Meta分析结果:与开腹组比较,腹腔镜组术中出血量较少[均数差(MD)=-58.7,95%CI:-76.94^-40.42,P<0.01],术后总体并发症发生率较低(RR=0.51,95%CI:0.35~0.73,P<0.01),术后肠排气时间较短(MD=-1.30,95%CI:-1.52^-1.07,P<0.01),住院时间较短(MD=-3.94,95%CI:-5.69^-2.20,P<0.01);在手术时间(MD=9.48,95%CI:-9.75~28.7,P>0.05)、淋巴结清扫数(MD=-0.98,95%CI:-2.83~0.86,P>0.05)、局部复发率(RR=0.59,95%CI:0.34~1.02,P>0.05)、远处转移率(RR=0.75,95%CI:0.35~1.62,P>0.05)、1年总体生存率(RR=1.06,95%CI:0.94~1.19,P>0.05)、5年总体生存率(RR=1.06,95%CI:0.83~1.36,P>0.05)方面比较,差异均无统计学意义。结论腹腔镜中低位直肠癌保肛手术是安全、可行的,具有术后恢复快、并发症发生率低、住院时间短等优点。

Objective To compare the clinical efficacy of laparoscopic versus open surgery with anal sphincter preservation for mid-low rectal cancer. Methods Databases of Pubmed, Embase, Cochrane library, CNKI and WanFan from inception to October 2017 were searched to retrieve randomized controlled trials（RCTs） about comparison of laparoscopic surgery to open surgery with anal sphincter preservation for mid-low rectal cancer. Meta-analysis was performed with RevMan5.3 software. Results Eleven RCTs involving 1090 patients were finally included. Compared with open surgery group, the laparoscopic surgery group had lower intraoperative blood loss（MD=-58.7, 95%CI：-76.94^-40.42, P〈0.01） and incidence of overall postoperative complications（RR=0.51, 95%CI：0.35~0.73, P〈0.01）, had shorter time of bowel function recovery（MD=-1.30, 95% CI：-1.52^-1.07, P〈0.01） and length of hospital stay（MD=-3.94, 95% CI：-5.69^-2.20, P〈0.01）. There were no statistical differences in the operative time（MD=9.48, 95%CI：-9.75~28.7, P〈0.05）, number of removed lymph nodes（MD=-0.98, 95%CI：-2.83~0.86, P〈0.05）, local recurrence rate（RR=0.59, 95%CI：0.34~1.02, P〈0.05）, distant metastasis rate（RR=0.75, 95%CI：0.35~1.62, P〈0.05）, 1-year overall survival rate（RR=1.06, 95%CI：0.94~1.19, P〈0.05） and 5-year overall survival rate（RR=1.06, 95% CI：0.83~1.36, P〈0.05） between two groups. Conclusion Laparoscopic surgery with anal sphincter preservation has advantage of rapid postoperative recovery, less total complications and shorter hospital stay, which is safe and feasible for mid-low rectal cancer.