尾侧联合中间入路与中间入路腹腔镜右半结肠癌根治术的Meta分析

Caudal combined intermediate approach versus intermediate approach in laparoscopic radical resection of right colon cancer:a meta-analysis

目的:比较尾侧联合中间入路与中间入路腹腔镜右半结肠癌根治术的安全性及临床疗效。方法:计算机检索PubMed、Embase、Cochrane Library、万方、中国知网、维普数据库比较尾侧联合中间入路与中间入路腹腔镜右半结肠癌根治术的随机对照试验或临床对照试验文献,检索日期截至2021年7月,对符合标准的文献提取相关数据后采用RevMan 5.4软件进行Meta分析。结果:共纳入2项随机对照试验、7项临床对照试验,834例患者,其中联合入路组419例,中间入路组415例。Meta分析结果显示,联合入路组手术时间短于中间入路组(WMD=-16.64,95%CI:-26.91~-6.38,P=0.001),术中出血量少于中间入路组(WMD=-11.69,95%CI:-19.2~-4.17,P=0.002),术后排气时间短于中间入路组(WMD=-0.07,95%CI:-0.13~-0.01,P=0.02)。两组淋巴结清扫数量(WMD=-0.47,95%CI:-1.10~0.15,P=0.14)、术后进食时间(WMD=-0.07,95%CI:-0.15~0.01,P=0.08)、术后住院时间(WMD=-0.07,95%CI:-0.32~0.17,P=0.55)、术后并发症发生率(OR=0.97,95%CI:0.60~1.55,P=0.89)、中转开腹率(OR=0.65,95%CI:0.18~2.35,P=0.51)差异无统计学意义。结论:经尾侧联合中间入路行腹腔镜右半结肠癌根治术是安全、可行的,在手术时间、术中出血量、胃肠道功能恢复方面优于中间入路。

Objective:To systematically compare the safety and clinical efficacy of caudal combined intermediate approach versus intermediate approach in laparoscopic radical resection of right colon cancer.Methods:The English and Chinese databases such as PubMed,Embase,Cochrane Library,Wanfang,CNKI and VIP were searched to retrieve randomized controlled trials or clinical controlled trials comparing caudal combined intermediate approach with intermediate approach in laparoscopic radical resection of right colon cancer,the retrieval date was up to Jul.2021.Relevant data conforming to standards were extracted from the literatures and meta-analysis was performed using RevMan 5.4 software.Results:Two randomized controlled trials and seven clinical controlled trials with 834 patients were included in this study,there were 419 patients in the combined approach group and 415 patients in the intermediate approach group.Meta-analysis showed that compared with the intermediate approach group,combined approach group had shorter operative time(WMD=-16.64,95%CI:-26.91~-6.38,P=0.001),less intraoperative blood loss(WMD=-11.69,95%CI:-19.2~-4.17,P=0.002),and earlier postoperative gastrointestinal peristalsis recovery time(WMD=-0.07,95%CI:-0.13~-0.01,P=0.02).There were no significant differences in the number of lymph node dissection(WMD=-0.47,95%CI:-1.10~0.15,P=0.14),postoperative feeding time(WMD=-0.07,95%CI:-0.15~0.01,P=0.08),postoperative hospital stay(WMD=-0.07,95%CI:-0.32~0.17,P=0.55),postoperative complications(OR=0.97,95%CI:0.60~1.55,P=0.89)and intraoperative conversion rate(OR=0.65,95%CI:0.18~2.35,P=0.51)between the two groups.Conclusions:The caudal combined with intermediate approach laparoscopic radical resection of right colon cancer is safe and feasible,and has advantages in operation time,intraoperative blood loss and recovery of gastrointestinal function compared with intermediate approach.