腹腔镜直肠癌前切除术中保留左结肠动脉与否的Meta分析

目的系统评价腹腔镜直肠癌前切除术中保留左结肠动脉是否安全有效。 方法检索PubMed、EMBase、Cochrane图书馆、Sinomed、万方、维普、中国知网等数据库，文献检索起止时间均从建库至2018年2月。对纳入文献进行质量评价和数据提取，应用Revman 5.3软件进行Meta分析。 结果共纳入12篇文献1 863例患者，其中高位结扎（HT）组937例，低位结扎（LT）组926例。与HT组相比，LT组吻合口瘘发生率（OR=2.77，95%CI=1.73~4.42，P<0.001）、游离脾曲（OR=13.00，95%CI=3.90~43.37，P<0.001）及预防性回肠造口（OR=2.29，95%CI=1.55~3.38，P<0.001）均下降；两组肠系膜下动脉根部淋巴结清扫数（WMD=0.03，95%CI= -0.14~0.21，P=0.69）、总淋巴结清扫数（WMD=0.40，95%CI= 0~0.80，P=0.05）及复发转移率（OR=0.96，95%CI= 0.68~1.35，P=0.79）差异无统计学意义。HT组手术时间短于LT组（WMD=-7.06，95%CI= -10.75~-3.36，P<0.001）。 结论腹腔镜直肠癌前切除术中低位结扎肠系膜下动脉，在吻合口瘘等近期疗效指标有获益，但在复发转移无获益。

Preservation of left colon artery or not in laparoscopic anterior resection of rectal cancer: A Meta-analysis

ObjectiveTo systematically review the safety and effectiveness of preserving the left colic artery (LCA) in laparoscopic anterior resection of rectal cancer. MethodsA literature search was conducted on the databases which included the PubMed, EMBase, Cochrane library, Sinomed, Wanfang, VIP, and CNKI. The retrieval time was from inception to February 2018. Meta analysis was performed using Revman 5.3 software. ResultsA total of 1 863 patients were included in 12 articles. Among them, 937 cases were high tie group (preservation of LCA), and 926 cases in the low tie group (without preservation of LCA). Compared with group HT, the anastomotic leakage (OR=2.77; 95%CI: 1.73, 4.42; P<0.001), free splenic flexure (OR=13.00; 95%CI: 3.90, 43.37; P<0.001) and prophylactic ileostomy (OR=2.29; 95%CI: 1.55, 3.38; P<0.001) in group LT were all decreased. There were no significant differences in the number of lymph nodes removed around the root of inferior mesenteric artery (WMD=0.03; 95%CI: -0.14, -0.21; P=0.69) , the total of lymph nodes dissection (WMD=0.40; 95%CI: 0, 0.80; P=0.05) and the rate of the recurrence and metastasis (OR=0.96; 95%CI: 0.68, 1.35; P=0.79). The operation time of group HT was shorter than that of group LT (WMD=-7.06; 95%CI: -10.75, -3.36; P<0.001). ConclusionLow ligation of inferior mesenteric artery and preservation of LCA has benefit in recent therapeutic effects such as anastomotic leakage, but there was no benefit in relapse or metastasis.