折刀俯卧位行低位直肠癌切除术疗效的Meta分析

Effect of low rectal cancer resection in the prone jackknife position:a Meta-analysis

[目的]系统评价折刀俯卧位下行低位直肠癌切除术的有效性。[方法]检索the Cochrane Library、PubMed、中国生物医学文献服务系统、中国知网(CNKI)、万方医学网中文期刊库,按照纳入及排除标准筛选关于折刀俯卧位与截石位低位直肠癌切除术的临床对照研究,提取纳入研究中有关手术时间、出血量、围术期并发症、局部肿瘤复发、病死率的数据并进行Meta分析。[结果]最终纳入4项研究,共386例病人。Meta分析显示折刀俯卧位组与截石位组的平均手术时间差异无统计学意义[MD=-2.82,95%CI(-16.52,22.16),P=0.78],术后会阴切口愈合不良发生率差异无统计学意义[RR=0.63,95%CI(0.32,1.23),P=0.170];两组在出血量[MD=-42.37,95%CI(-80.02,-4.73),P=0.030]、肿瘤局部复发[RR=0.26,95%CI(0.11,0.61),P=0.002]和病死率[RR=0.45,95%CI(0.21,0.95),P=0.030]方面差异有统计学意义。[结论]现有证据表明,折刀俯卧位行低位直肠癌切除术可有效减少出血,改善病人预后。

Objective:To systematically evaluate the effectiveness of lower rectal cancer resection in the prone jackknife position.Methods:The Cochrane Library,PubMed,CBM,CNKI and WanFang Databases were retrieved.According to the inclusion and exclusion criteria,clinical control studies of lower rectal cancer resection in jackknife position and lithotomy position was screened.Data on surgical time,bleeding volume,perioperative complications,local tumor recurrence and mortality were extracted and analyzed by taking Meta-analysis.Results:Four studies were included,involving 386 cases.The Meta-analysis results showed that there were no significant difference in the mean surgical time[MD=-2.82,95%CI(-16.52,-22.16),P=0.78]and the incidence of poor perineal incision healing[RR=0.63,95%CI(0.32,1.23),P=0.170]between the jackknife position group and the lithotomy position group.There were significant differences in bleeding volume[MD=-42.37,95%CI(-80.02,-4.73),P=0.030],local tumor recurrence[RR=0.26,95%CI(0.11,0.61),P=0.002]and mortality[RR=0.45,95%CI(0.21,0.95),P=0.030].Conclusions:The current evidence shows that the prone jackknife position in lower rectal cancer resection can effectively reduce bleeding and improve the prognosis of patients.