中国实用外科杂志

中国实用外科杂志

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腹腔镜与开腹结肠癌完整结肠系膜切除术比较Meta分析

王文韬，冯    勇   

  1. 中国医科大学附属盛京医院结肠直肠肿瘤外科，辽宁沈阳 110004
  • 出版日期:2015-01-01 发布日期:2014-12-31

  • Online:2015-01-01 Published:2014-12-31

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摘要：

目的    采用循证医学荟萃分析的方法评价腹腔镜完整结肠系膜切除（complete mesocolic excision， CME）在结肠癌手术治疗中应用的可行性与安全性。 方法    计算机检索 Cochrane library、Pubmed、OVID、Springer Linker、Science Direct、EBSCO、中国知网、维普医药信息资源系统、万方数据医药系统等中外生物医学数据库，检索近6年来有关比较腹腔镜与开腹完整结肠系膜切除术的临床对照研究。按Cochrane系统评价方法 ，评价所纳入研究的文献质量，并提取有效数据后采用Review-Manager5.3软件进行Meta分析。 结果    共纳入8篇文献。计有病例2179例，其中腹腔镜CME组1128例，开腹CME组1051例。Meta分析结果显示：（1）腹腔镜CME术中出血量少于开腹CME组（WMD=-54.44，95%CI：-105.38~-3.49，P=0.04），手术时间与开腹CME组差异无统计学意义（WMD=28.78,95%CI：-4.66~62.21，P=0.09）；（2）腹腔镜CME在术后首次排气排便时间（WMD=-17.19，95%CI：-29.71~-4.67，P=0.007）、术后并发症（OR=0.57，95%CI：0.43~0.75，P<0.0001）上小于开腹CME，在手术死亡率上两组差异无统计学意义（P=0.21）；（3）腹腔镜CME切除结肠长度与开腹CME无统计学意义（WMD=-2.83,95%CI：-5.88~0.22，P=0.07），在淋巴结检出数上腹腔镜CME少于开腹CME（WMD=-1.70，95%CI：-1.88~-1.53，P<0.00001），但在阳性淋巴结检出数上腹腔镜CME多于开腹CME（WMD=0.6，95%CI：0.51~0.68，P<0.00001）；（4）局部复发率、远处转移率、5年存活率、5年无病存活率两组差异均无统计学意义（分别为P=0.43、P=0.29、P=0.44、P=0.52）。结论    腹腔镜辅助下的结肠癌完整结肠系膜切除是安全有效的。

关键词: 结肠肿瘤, 完整结肠系膜切除, 腹腔镜, Meta分析

Abstract:

Laparoscopic versus open surgery for complete mesocolic excision with colon cancer: A Meta-analysis                         WANG Wen-tao, FENG Yong.
Department of Colorectal Cancer Surgery, Shengjing Hospital, China Medical University, Shenyang 110004,China
Corresponding author: FENG Yong, E-mail: fengy@sj-hospital.org
Abstract    Objective    To systemically assess the feasibility and safety of laparoscopic complete mesocolic excision(CME) for colon cancer. Method    A search of Cochrane library, Pubmed, OVID, Springer Linker, Science Direct, EBSCO, CNKI, VIP and Wanfang database was undertaken and studies published in the last six years were identified. We included controlled clinical trials that compared laparoscopic CME and open CME for colon cancer in our Meta-analysis. Studies selection and Meta-analysis were performed using Review-Manager 5.3 software according to the Cochrane Handbook. Results    A total of 2179 patients undergoing colon cancer surgery ( laparoscoPic CME group n= 1128, open CME group n= 1051) were examined. Meta-analysis showed that: (1) The amount of bleeding during operation in the laparoscopic CME group was smaller than open CME group（WMD=-54.44,95%CI：-105.38~-3.49，P=0.04）.There was no significant differences in the amount of operation time（WMD=28.78,95%CI：-4.66~62.21，P=0.09）between laparoscopic CME group and open CME group; (2) The significant differences lie in the time of first flatus（WMD= -17.19, 95%CI: -29.71~ -4.67, P=0.007） and the postoperative complication（OR=0.57,95%CI：0.43~0.75，P<0.0001）, in which the datas of the laparoscopic CME group was smaller than that of the open CME group. No significant difference was found in the mortality(P=0.21) between two kinds of operative methods; (3) There was no significant difference in the length of large bowel resection （WMD=-2.83,95%CI：-5.88~0.22，P=0.07）. Meanwhile, compared with the open CME group, the number of lymph node of the laparoscopic CME group was less（WMD=-1.70，95%CI：-1.88~-1.53，P<0.00001）, while the number of positive lymph node was more（WMD= 0.6, 95%CI: 0.51~ 0.68, P<0.00001）; (4) In the long-term effects, there were no significant differences in the local recurrence rate, distant Metastasis rate, 5-years survival rate and disease free survive(DFS)(P= 0.43, P=0.29, P=0.44, P=0.52 resPectively). Conclusion    laparoscopic CME is safe and effective in the treatment of colon cancer.

Key words: colon cancer, complete mesocolic excision, laparoscopic, Meta-analysis