经肛提肌外腹会阴联合切除术与传统腹会阴联合切除术对低位直肠癌疗效比较的Meta分析

目的系统比较经肛提肌外腹会阴联合切除术（ELAPE）与传统腹会阴联合切除术（APE）对低位直肠癌的治疗效果。方法计算机检索Cochrane图书馆、PubMed、EMbase、中国知网和维普等数据库中以低位直肠癌为研究对象、并设有ELAPE与APE对照的临床研究文献，采用Cochrane系统评价方法对两种术式的术中穿孔率、环周切缘阳性率、术后局部复发率及术后会阴切口并发症发生率进行Meta分析。结果共6篇文献（1篇随机对照研究和5篇非随机对照研究）656例病例纳入研究，其中ELAPE组346例，APE组310例。Meta分析结果显示，ELAPE组环周切缘阳性率（RR=0．48，95％CI：0．36-0．65）和局部复发率（RR=0．43，95％C1：0．19-0．99）明显低于APE组；而两组患者术中穿孔率（RR=0．45，95％CI：0．15-1．37）和术后会阴切口并发症发生率（RR=I．20，95％CI：0．57-2．50）的差异无统计学意义。结论相较于传统APE术，ELAPE术具有更低的环周切缘阳性率和局部复发率。

Meta-analysis of extralevator abdominoperineal excision and conventional abdominoperineal excision for low rectal cancer

Objective To evaluate the perforation, circumferential resection margin （CRM） and postoperative perineal wound complications after extralevator abdominoperineal excision （ELAPE） and conventional abdominoperineal excision （APE） for low rectal cancer by using systematic review method. Methods The Cochrane Library, PubMed, EMbase, CNKI and VIP database were searched for literatures in which ELAPE and APE were compared for the treatment of low rectal cancer. Meta-analysis was performed to deal with data extracted by Cochrane Systematic Reviews methods. Results Six studies met the inclusion criteria including one randomized control study and five non-randomized control studies with a total of 656 cases including 346 cases of ELAPE and 310 cases of APE. Meta-analysis showed a lower positive CRM rate （RR=0.48, 95%CI： 0.36-0.65） and a lower local recurrence rate （RR=0.43, 95%CI：0.19-0.99） in ELAPE compared with APE. There were no significant differences in operative perforation rate （RR =0.45, 95% CI： 0.15-1.37） and post-operative perineal wound complications rate （RR=I.20, 95%CI：0.57-2.50） between the two surgical procedures. Conclusion ELAPE is associated with lower rates of positive CRM and local recurrence compared with APE.