国内腹腔镜与开腹全直肠系膜切除术治疗直肠癌近期疗效比较的Meta分析

目的 评价国内腹腔镜下行全直肠系膜切术（TME）治疗直肠癌的近期疗效.方法 系统检索2003年1月至2013年10月公开发表的腹腔镜与开腹TME手术治疗直肠癌的随机对照研究或设计良好的回顾性分析研究,由2名评价员独立筛选并提取数据资料,对符合纳入标准的研究使用Revman 5.2软件进行统计分析.结果 按照筛选标准,共计17篇随机对照实验（RCT）,3篇回顾性病例分析纳入研究,病例总数2246例.腹腔镜手术（LS）组与开腹手术（OS）组患者一般情况及病历特征分布均衡.结果显示,与OS组相比,LS组术后切口感染（RR =0.30,95％ CI：0.17 ～0.54,P＜0.01）、肺部感染（RR=0.47,95％ CI：0.25～0.91,P＜0.05）以及肠梗阻发生率（RR =0.41,95％ CI：0.19 ～0.88,P＜0.05）均明显降低,而腹腔脓肿（RR=0.78,95％ CI：0.38～1.60,P＞0.05）、吻合口瘘（RR=0.66,95％ CI：0.38 ～ 1.16,P＞0.05）及尿潴留（RR=0.57,95％ CI：0.26～ 1.25,P＞0.05）并发症的发生率两组之间差异无统计学意义（P＞0.05）.另外,在术后恢复的各项参数比较中,LS组均优于OS组（P＜0.01）.结论 腹腔镜实施TME手术治疗直肠癌具有创伤小、术后恢复快、并发症少的特点,安全可行,极具前景.

A meta-analysis of short-term outcomes of laparoscopic and open total mesorectal excision for rectal cancer in China

Objective To investigate the clinical short-term outcomes after laparoscopic total mesorectal excision （TME）for rectal cancer in China.Methods A systematic literature searching was performed to identify all randomized controlled trial（RCT） studies or well-designed retrospective studies on laparoscopic surgery（LS） and open surgery（OS） for rectal cancer published from January 2003 to October 2010 in China.Two reviewers independently screened and extracted the data.The reports which matched the inclusion criteria were analyzed with Revman 5.2.Results A total of 17 RCT studies and 3 retrospective studies （2246 patients）was included in this study.The basic features of 2 groups were balance.Compared to group OR,the incidence of complications such as postoperative wound infection （RR =0.30,95 % CI：0.17 ～0.54,P 〈 0.01）,pulmonary infection （RR =0.47,95% CI：0.25 ～0.91,P 〈0.05）,and ileus （RR =0.41,95% CI：0.19 ～0.88,P 〈0.05）were significantly lower in group LS.No difference was observed in the incidence of peritoneal abscess（RR =0.78,95% CI：0.38 ～ 1.60,P 〉0.05）,anastomotic leakage（RR =0.66,95% CI：0.38 ～ 1.16,P 〉0.05）,and uroschesis（RR =0.57,95% CI：0.26 ～ 1.25,P 〉0.05）.Furthermore,parameters of postoperative recovery were compared between groups,LS group manifested early recovery.Conclusions Laparoscopic total mesorectal excision for rectal cancer,with minimal invasion,benefits the postoperative recovery and reduces incidence of complications.LS radical resection of rectal cancer is technically feasible,safe,and prospectively favorable.