文章摘要
彭雪婷,朱 琨,闫 融,李 康.直肠癌腹腔镜手术长期疗效并不优于开腹手术:近10年经典随机对照试验的荟萃分析[J].南京医科大学学报,2019,(6):932~940
直肠癌腹腔镜手术长期疗效并不优于开腹手术:近10年经典随机对照试验的荟萃分析
Laparoscopic surgery for rectal cancer is not superior to open surgery in long⁃term efficacy:a Meta⁃analysis of classic randomized controlled trials in the last 10 years
投稿时间:2018-12-17  
DOI:10.7655/NYDXBNS20190629
中文关键词: 直肠癌  腹腔镜手术  开腹手术  Meta分析
英文关键词: rectal cancer  laparoscopic surgery  open surgery  Meta⁃analysis
基金项目:国家自然科学基金项目(81370069)
作者单位
彭雪婷 西安交通大学医学部陕西 西安 710061 
朱 琨 西安交通大学第一附属医院肿瘤外科陕西 西安 710061 
闫 融 西安交通大学第一附属医院肿瘤外科陕西 西安 710061 
李 康 西安交通大学第一附属医院肿瘤外科陕西 西安 710061 
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中文摘要:
      目的:对近10年已发表的高质量经典随机对照试验(randomized controlled trial,RCT)进行腹腔镜手术与开腹手术治疗直肠癌的Meta分析。方法:利用电子数据库和手工检索等方法检索Pubmed、Embase、Web of Science、OVID、CNKI、万方数据库及Cochrane Library 2007年1月1日—2018年11月1日的相关研究RCT文献,对所有符合条件的文献进行Jadad质量评分。采用固定效应模型和随机效应模型对直肠癌腹腔镜手术与开腹手术的手术情况及疗效指标进行Meta分析。结果:符合入选标准的RCT文献有14篇共计3 288例患者,腹腔镜手术组与开腹手术组分别为1 779例和1 509例。Meta分析结果显示,直肠癌腹腔镜手术相较于开腹手术的手术时间更长(MD=40.04,95%CI:24.07~56.01,P <0.05),术中出血量更少(MD=-98.48,95%CI:-148.72~-48.25,P < 0.05),术中输血率更低(OR=0.30,95%CI:0.16~0.55,P < 0.05),术后肠功能恢复时间更短(MD=-0.68,95%CI:-0.98~-0.38,P < 0.05),术后住院时间更短(MD=-1.08,95%CI:-1.49~-0.66,P < 0.05),术后发病率更低(OR=0.67,95%CI:0.46~0.97,P < 0.05),术后切口感染发生率更低(OR=0.52,95%CI:0.36~0.77,P < 0.05)。但在肿瘤距近切和远切缘距离、淋巴结检出数量、环周切缘阳性率、术后二次手术发生率、术后并发症(肠梗阻、腹部感染、肺部感染、吻合口瘘、吻合口出血、吻合口狭窄)、术后局部复发率、术后3年生存率、术后5年生存率和术后5年无病生存率方面均未见统计学差异。结论:直肠癌腹腔镜手术对比开腹手术,手术时间更长,术中出血量更少,术中输血率更低,术后肠功能恢复时间更短,术后切口感染发生率更低,但在淋巴结获取数目、环周切缘阳性率、局部复发率、3年生存率、5年生存率等长期预后等指标上无差异。
英文摘要:
      Objective:To present a meta?analysis of high?quality published and classic randomized controlled trials(RCTs)in the past decade in comparison to laparoscopic surgery(LS)and open surgery(OS)for rectal cancer. Methods:Electronic literature search was performed on PubMed,EMBASE,Web of Science,OVID,CNKI,Wanfang Data and Cochrane Library from January 1,2007 to November 1,2018. All eligible RCTs were evaluated based on the Jadad score. We used the fixed effect model(FE)and the random effect model(RE)to analyze this cohort. Results:Among all the 14 included studies,a total of 3 288 cases were reported,including 1 779 patients in the LS group and 1 509 patients in the OS group. The results of the Meta?analysis demonstrated the operative time of the LS group was obviously longer than that of the OS group(MD=40.04,95%CI[24.07,56.01],P < 0.05),LS was associated with less blood loss(MD=-98.48,95%CI[-148.72,-48.25],P < 0.05),fewer blood transfusions(OR=0.30,95%CI[0.16,0.55],P < 0.05),shorter bowel function recovery times(MD=-0.68,95%CI[-0.98,-0.38],P < 0.05),shorter postoperative hospital stays(MD=-1.08,95%CI[-1.49,-0.66],P < 0.05),fewer postoperative complications(OR=0.67,95%CI[0.46,0.97],P < 0.05)and fewer wound infections(OR=0.52,95%CI[0.36,0.77],P < 0.05). However,no significant differences between the LS and OS groups were proximal resection margin,radial distal margin,the number of harvested lymph nodes,positive circumferential resection margin(CRM),reoperation,other postoperative complications(ileus,abdominal infection,lung infection,anastomotic fistula,anastomosis bleeding and anastomosis stenosis),local recurrence,3?year overall survival,5?year overall survival or 5?year disease?free survival. Conclusion:There are no significant differences between LS and OS in terms of the number of harvested lymph nodes,positive CRM,local recurrence or overall survival. More,LS for rectal cancer appears to be safer in blood loss,blood transfusions,bowel function recovery times and wound infections in comparison to OS.
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