中国实用外科杂志

中国实用外科杂志

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腹腔镜与开放手术行超低位直肠癌肛门括约肌间切除Meta分析

李昌荣，李伟峰，李红浪   

  1. 南昌大学第二附属医院胃肠外科，江西南昌 330006
  • 出版日期:2015-08-01 发布日期:2015-07-27

  • Online:2015-08-01 Published:2015-07-27

摘要：

目的    比较腹腔镜与开放手术行超低位直肠癌肛门括约肌间切除（ISR）的安全性和有效性。方法    检索2014年12月前PubMed、Medline、Ovid、CNKI和万方数据库中所有对比腹腔镜和开放手术行超低位直肠癌ISR的文献。将符合文献质量评价标准的文献纳入后，根据研究的异质性分别采用固定效应模型或随机效应模型进行荟萃分析。结果    纳入10篇观察性研究共939例病人，腹腔镜手术和开放手术分别为501例和438例。与开放组相比，腹腔镜组手术时间（WMD=36.28，95%CI 4.30～68.26，P<0.05）延长，术中出血量（WMD=-95.84，95%CI -123.64～-68.03，P<0.01）减少，术后肛门排气时间（WMD=-1.05，95%CI -1.70~-0.41，P<0.01）、正常饮食时间（WMD=-0.95，95%CI -1.34~-0.55，P<0.01）和正常住院时间（WMD=-2.43，95%CI -3.95~-0.92，P<0.01）均缩短，总体术后并发症发生率（OR=0.60，95%CI 0.44～0.84，P<0.01）、环周切缘阳性率（OR=2.49，95%CI 1.12~5.54，P<0.05）和切口感染发生率（OR=0.20，95%CI 0.07~0.60，P<0.01）均降低；两组在局部复发率、远处转移率、吻合口漏及术后肠梗阻发生率方面差异均无统计学意义（均P>0.05）。结论    腹腔镜手术行超低位直肠癌ISR短期及长期疗效满意，是一种微创、安全的保肛手术方法。

关键词: 腹腔镜, 肛门括约肌间切除, 直肠癌, Meta分析

Abstract:

Laparoscopic intersphincteric resection versus open intersphincteric resection in sphincter-preserving surgery of ultralow rectal carcinom：A Meta-analysis        LI Chang-rong，LI Wei-feng，LI Hong-lang. Department of Gastrointestinal Surgery，the Second Affiliated Hospital of Nanchang University，Nanchang330006，China
Corresponding author：LI Hong-lang，E-mail：lihonglang6802@163.com
Abstract    Objective    To compare the clinical safety and efficacy of laparoscopic intersphincteric resection versus open intersphincteric resection in sphincter-preserving surgery of ultralow rectal carcinom. Methods    Studies comparing laparoscopic intersphincteric resection with open intersphincteric resection in sphincter-preserving surgery of ultralow rectal carcinoma were retreived from PubMed，Medline，Ovid，China National Knowledge Infrastructure (CNKI) and Wanfang databases by 2014. The methodological quality of the selected studies was assessed to determine studies suitable for inclusion. Meta-analysis was performed by fixed or random effects model. Results    Ten observational studies with a total of 939 patients (501 patients in laparoscopic surgery groups and 438 patients in open surgery groups) were identified. Compared with open surgery group，laparoscopic surgical operation time extended（WMD=36.28，95%CI 4.30—68.26，P<0.05），intraoperative bleeding reduced (WMD=-95.84，95%CI -123.64—-68.03，P＜0.01)，time of bowel function recovering（WMD=-1.05，95%CI -1.70—-0.41，P<0.01），normal dieting (WMD=-0.95，95%CI -1.34—-0.55，P<0.01) and hospital staying (WMD=-2.43，95%CI -3.95—-0.92，P<0.01) shortened respectively. Incidence of overall postoperative complication（OR=0.60，95%CI 0.44—0.84，P<0.01），positiving circumferential resection margin (OR=2.49，95%CI 1.12—5.54，P<0.05) and wound infection（OR=0.20，95%CI 0.07—0.60，P<0.01） reduced respectively. No statistically significant difference was found on the local recurrence rate，distant metastasis，anastomotic leakage，postoperative intestinal obstruction between the two groups (P>0.05). Conclusion    Laparoscopic-assisted intersphincteric resection is a technically feasible and safe alternative to open surgery with better short-term and long-term postoperative outcomes for ultralow rectal carcinoma.

Key words: laparoscopy, intersphincteric resection, rectal carcinoma, Meta-analysis