CAJ | 학술논문

目的系统评价腹腔镜与开腹手术切除治疗结直肠癌的疗效及安全性.方法采用Cochrane系统评价方法,检索Embase、PubMed、Cochrane图书馆、Sciencedirect、Springer、VIP、CNKI、CBMdisc等数据库中2000年1月至2010年10月公开发表的腹腔镜与开腹手术切除治疗结直肠癌的随机对照试验(RCT),对符合纳入标准的研究进行质量评价和资料提取,并采用RevMan 5.0对腹腔镜与开腹手术切除治疗结直肠癌的疗效及安全性进行meta分析.结果共纳入13项RCT,共计4603例患者.其中6项为多中心RCT.meta分析结果显示:腹腔镜组手术时间长于开腹组(加权均数差值WMD=38.91,95% CI:33.89～43.93,P＜0.001),术中失血量少于开腹组(WMD=-138.14,95% CI:-195.79～-80.50,P＜0.001),总住院时间少于开腹组(WMD=2.91,95%CI:-4.65～-1.17,P=0.001);两组淋巴结清扫数量、术后并发症(30 d)发生率、3年总生存率、5年总生存率、5年总复发率的差异均无统计学意义(均为P＞0.05).结论腹腔镜辅助下行结直肠癌根治术的短期和长期结果均表明其有效并且安全,有望成为结直肠癌治疗的新选择.
목적 계통평개복강경여개복수술절제치료결직장암적료효급안전성.방법 채용Cochrane계통평개방법,검색Embase、PubMed、Cochrane도서관、Sciencedirect、Springer、VIP、CNKI、CBMdisc등수거고중2000년1월지2010년10월공개발표적복강경여개복수술절제치료결직장암적수궤대조시험(RCT),대부합납입표준적연구진행질량평개화자료제취,병채용RevMan 5.0대복강경여개복수술절제치료결직장암적료효급안전성진행meta분석.결과 공납입13항RCT,공계4603례환자.기중6항위다중심RCT.meta분석결과현시:복강경조수술시간장우개복조(가권균수차치WMD=38.91,95% CI:33.89～43.93,P＜0.001),술중실혈량소우개복조(WMD=-138.14,95% CI:-195.79～-80.50,P＜0.001),총주원시간소우개복조(WMD=2.91,95%CI:-4.65～-1.17,P=0.001);량조림파결청소수량、술후병발증(30 d)발생솔、3년총생존솔、5년총생존솔、5년총복발솔적차이균무통계학의의(균위P＞0.05).결론 복강경보조하행결직장암근치술적단기화장기결과균표명기유효병차안전,유망성위결직장암치료적신선택.
Objective To evaluate and compare the efficiency and safety of laparoscopic surgery (LS) and open surgery (OS) in the treatment of colorectal carcinoma. Methods Randomized controlled trials on laparoscopic surgery and open surgery for colorectal carcinoma from January 2000 to October 2010were searched in the databases of EMbase, PubMed, Cochrane Library, Sciencedirect, Springer, VIP,CNKI, CBMdisc. The methodological quality was assessed according to the standard of Cochrane systematic review. For homogeneous studies, RevMan5.0 software was used for meta-analysis. Results A total of 13 RCTs involving 4603 patients were included in this study, and among those 6 were multi-center randomized controlled trials. The meta-analysis showed that: the operation time of the LS group was longer than that of the OS group ( WMD = 38. 91, 95% CI: 33.89-43.93, P ＜ 0. 001 ), the blood loss ( WMD =- 138. 14, 95% CI:-195. 79-80. 50, P ＜ 0. 001 ) and the length of hospital stay ( WMD = 2. 91, 95%CI: -4. 65-1.17, P =0. 001 ) of the LS group was less than those in OS group. There was no significant differences between the two groups in the number of dissected lymph nodes( WMD = -0. 62, 95% CI:- 1.47-0. 23, P = 0.150). There was no significant differences between the two groups in terms of the postoperative complications(30 days) (RR =0.78,95% CI:0. 59-1.01, P = 0. 06 ). There was no significant differences between the two groups in 3-year overall survival ( RR = 1.00, 95% CI :0. 96-1.04, P = 0. 970).There was no significant differences between the two groups in 5-year overall survival (RR = 1.03, 95% CI:0. 99-1.08, P = 0. 140 ). There was no significant differences between the two groups in 5-year overall recurrence ( RR = 0. 89,95% CI:0. 74-1.07, P = 0. 200). Conclusions Laparoscopic surgery for colorectal carcinoma is a safe and effective therapy as open surgery in the short term or long term outcomes. It could be an acceptable alternative to open surgery for colorectal carcinoma.