结肠癌完整结肠系膜切除术的可行性与安全性的Meta分析

目的评价结肠癌完整结肠系膜切除术（CME）的可行性与安全性。方法计算机检索万方、CNKI、CBM、维普、PubMed、Medline、OVID、Elsevier、IsIWebofKnowledge平台（SCI、ISIP、CCR、IC）和Cochrane等近5年来公开发表的有关CME与传统结肠癌手术的随机对照试验（RCT）或非随机对照试验（RNT）文献，严格按标准筛选后，评估文献质量并提取数据资料，最后用ReviewManager5．1软件进行系统评价。结果共纳入8篇非随机对照试验文献。计有病例1209例，其中CME组615例，对照组594例。Meta分析结果显示：（1）CME在术中出血量少于传统手术（WMD=-13．05，95％CI：-25．03—1．07，P=0．03），在手术时间上两组差异无统计学意义（WMD=O．46，95％CI：-26．50～27．41，P=0．97）；（2）CME在术后病理标本淋巴结检出数、平均切除结肠长度和系膜面积以及营养血管长度等方面均优于传统结肠癌手术（分别为P〈0．01、P〈0．01、P〈0．01和P〈0．05）；（3）两组术后首次排气时间和住院时间差异无统计学意义（P=0．87，P=0．05）；（4）CME并没有增加手术并发症发生率（P=0．74）。结论CME符合胚胎解剖学、肿瘤外科学和精细外科学理念，安全、可行．有望成为结肠痛规范化的手术方式．

A meta-analysis of feasibility and safety in complete mesocolic excision for colon cancer

Objective To systemically assess the feasibility and safety of complete mesocolic exeision（CME） forcoloneancer. Methods A computer-based online research of prospective, randomized or nonrandomized, controlled studies addressing CME versus traditional surgery published in the last five years was performed in electronic databases （Wan-fang Database, China National Knowledge Infrastructure, Chinese Medical Current Contents, VIP, PubMed, Medline, Ovid, Elsevier, ISI Web of Knowledge, Coehrane Database of Systematic Reviews）. With strictly screening according to the standard, the quality of studies was evaluated. Selective trials were analyzed by the Review Manager 5.1 software. Results A total of eight nonrandomized clinical trials, involving a total of 1209 patients （615 patients in CME group and 594 patients in control group）, were identified. Meta- analysis showed that the intraoperative blood loss in CME group was less than that in control group [WMD=-13.05, 95%CI： -25.03 to -1.07, P=0.03]. No significant difference in the operation time was found[WMD=0.46, 95%CI： -26.50 to 27.41, P=0.97], and significant differences in the number of lymph node retrieved from postoperative pathologic specimens, the average length of large bowel resected, the area of mesentery resected, and the high vascular ligation were revealed between two groups. Besides there were no significant differences in the time to first flatus and the hospitalstay between two groups （P=0.87, P=0.05）. The postoperative complication morbidity did not increase in CME group as compared to control group （P=0.74）. Conclusion CME is safe and effective in accordance with the concept of embryonic anatomy, oncological surgery and delicate surgery, and is expected to become a standardization operation method for colon cancer.