腹腔镜对比传统开放手术治疗直肠癌临床效果的Meta分析

目的：对比腹腔镜直肠癌手术和传统开腹手术的临床效果。 方法：检索近20年来发表的关于比较腹腔镜与传统开腹手术治疗直肠癌临床效果的随机对照试验。按纳入标准筛选文献，用Review Manager 5.1软件行Meta分析。 结果：最终纳入14个随机对照试验，共2 114例患者，其中腹腔镜组1 111例，开腹组1 003例。腔镜组与传统开腹组比较，术中出血量少、胃肠功能恢复时间及下床活动时间早、住院时间缩短、伤口感染减少，差异均有统计学意义（均P<0.05）；手术并发症发生率包括输尿管损伤、尿潴留、肠梗阻、吻合口瘘，切口疝，两组组间差异均无统计学意义（均P>0.05）；两组在淋巴结清扫数量、标本长度、环周切缘阳性率、局部复发、切口或穿刺口种植转移、远处转移、3，5年总体生存率、3，5年无病生存率等指标上均无统计学差异（均P>0.05）。 结论：腹腔镜直肠癌手术术中出血少、术后恢复快、住院时间短，肿瘤根治效果与传统开腹手术相仿，可作为治疗直肠癌的标准术式。

Laparoscopic versus conventional open surgery for rectal cancer: a Meta-analysis

Objective: To compare the clinical efficacies between laparoscopic and conventional open surgery for rectal cancer. Methods: Literature search for randomized controlled trials (RCTs) comparing laparoscopic surgery to conventional open surgery for rectal cancer over the past 20 years was performed. The studies were screened according to the inclusion criteria, and then Meta-analysis was performed by using Review Manager 5.1 software. Results: Fourteen RCTs involving 2 114 patients were finally selected, with 1 111 cases in laparoscopic surgery group and 1 003 cases in open surgery group. Compared with open surgery group, in laparoscopic surgery group, the intraoperative blood loss, time to postoperative gastrointestinal function recovery and ambulation, length of hospital stay and wound infection were reduced, and all the differences reached statistical significance (all P<0.05). The incidence of operative complications that included ureteral injury, uroschesis, intestinal obstruction, anastomotic fistula, and incisional hernia showed no statistical difference between the two groups (all P>0.05). The number of removed lymph nodes, length of specimen, rate of positive circumferential resection margin, and incidence of local recurrence, tumor implantation of the incision or puncture hole, and distant metastasis, as well as the 3- and 5-year overall survival, and 3- and 5-year disease free survival between the two groups had no statistical difference (all P>0.05). Conclusion: Laparoscopic rectal cancer surgery has the similar efficacy in oncological outcomes as the conventional open surgery, with the advantages of reduced intra-operative blood loss, rapid postoperative recovery and shorter hospital stay. So it may be used as a standard procedure for rectal cancer.