中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2011年
8期
606-610
,共5页
黄美近%彭慧%王辉%梁景琳%饶本强%康亮%张兴伟%汪建平
黃美近%彭慧%王輝%樑景琳%饒本彊%康亮%張興偉%汪建平
황미근%팽혜%왕휘%량경림%요본강%강량%장흥위%왕건평
直肠肿瘤%腹腔镜手术%开腹手术%Meta分析
直腸腫瘤%腹腔鏡手術%開腹手術%Meta分析
직장종류%복강경수술%개복수술%Meta분석
Rectal neoplasms%Laparoscopic surgery%Open surgery%Meta-analysis
目的 探讨腹腔镜手术治疗直肠癌的肿瘤清除情况及长期疗效。方法 利用电子数据库和手工检索等方法检索Pubmed,Embase,Web of Science及Cochrane Library截止至2010年6月30日的所有随机对照试验(RCT)文献。评价指标为淋巴结获取数、肿瘤长期疗效(局部复发、切口复发、总体复发、总体生存率及无病生存率)。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肿瘤清除情况及长期疗效指标进行荟萃分析。结果 符合入选标准的RCT文献有6项共计1033例患者,腹腔镜手术组与开腹手术组分别为577例和456例。两组的淋巴结获取数差异无统计学意义(WMD=-0.38,95% CI:-1.35~0.58,P=0.43)。腹腔镜组环周切缘阳性率(7.94%)高于开腹手术组(5.37%),但差异无统计学意义[风险比(RR)=1.13,95% CI:0.69~1.85,P=0.63]。局部复发率比较,差异无统计学意义(RR=0.55,95% CI:0.22~1.40,P=0.21)。两组3年总体生存率比较[危险比(HR)=0.76,95% CI:0.54~1.07,P=0.11],差异无统计学意义;两组3年无病生存率比较(HR=1.16,95% CI:0.61~2.20,P=0.64),差异亦无统计学意义。结论 直肠癌腹腔镜手术在肿瘤清除及长期疗效方面至少与开腹手术相当。
目的 探討腹腔鏡手術治療直腸癌的腫瘤清除情況及長期療效。方法 利用電子數據庫和手工檢索等方法檢索Pubmed,Embase,Web of Science及Cochrane Library截止至2010年6月30日的所有隨機對照試驗(RCT)文獻。評價指標為淋巴結穫取數、腫瘤長期療效(跼部複髮、切口複髮、總體複髮、總體生存率及無病生存率)。採用固定效應模型和隨機效應模型對直腸癌腹腔鏡手術與開腹手術的腫瘤清除情況及長期療效指標進行薈萃分析。結果 符閤入選標準的RCT文獻有6項共計1033例患者,腹腔鏡手術組與開腹手術組分彆為577例和456例。兩組的淋巴結穫取數差異無統計學意義(WMD=-0.38,95% CI:-1.35~0.58,P=0.43)。腹腔鏡組環週切緣暘性率(7.94%)高于開腹手術組(5.37%),但差異無統計學意義[風險比(RR)=1.13,95% CI:0.69~1.85,P=0.63]。跼部複髮率比較,差異無統計學意義(RR=0.55,95% CI:0.22~1.40,P=0.21)。兩組3年總體生存率比較[危險比(HR)=0.76,95% CI:0.54~1.07,P=0.11],差異無統計學意義;兩組3年無病生存率比較(HR=1.16,95% CI:0.61~2.20,P=0.64),差異亦無統計學意義。結論 直腸癌腹腔鏡手術在腫瘤清除及長期療效方麵至少與開腹手術相噹。
목적 탐토복강경수술치료직장암적종류청제정황급장기료효。방법 이용전자수거고화수공검색등방법검색Pubmed,Embase,Web of Science급Cochrane Library절지지2010년6월30일적소유수궤대조시험(RCT)문헌。평개지표위림파결획취수、종류장기료효(국부복발、절구복발、총체복발、총체생존솔급무병생존솔)。채용고정효응모형화수궤효응모형대직장암복강경수술여개복수술적종류청제정황급장기료효지표진행회췌분석。결과 부합입선표준적RCT문헌유6항공계1033례환자,복강경수술조여개복수술조분별위577례화456례。량조적림파결획취수차이무통계학의의(WMD=-0.38,95% CI:-1.35~0.58,P=0.43)。복강경조배주절연양성솔(7.94%)고우개복수술조(5.37%),단차이무통계학의의[풍험비(RR)=1.13,95% CI:0.69~1.85,P=0.63]。국부복발솔비교,차이무통계학의의(RR=0.55,95% CI:0.22~1.40,P=0.21)。량조3년총체생존솔비교[위험비(HR)=0.76,95% CI:0.54~1.07,P=0.11],차이무통계학의의;량조3년무병생존솔비교(HR=1.16,95% CI:0.61~2.20,P=0.64),차이역무통계학의의。결론 직장암복강경수술재종류청제급장기료효방면지소여개복수술상당。
Objective To compare oncologic adequacy of resection and long-term oncologic outcomes between laparoscopic-assisted surgery (LS) and open surgery (OS) in the treatment of rectal cancer. Methods Literature searches of electronic databases (PubMed, Embase, Web of Science,and Cochrane Library) and manual searches up to June 30,2010 were performed to identify RCTs comparing values of oncologic adequacy of resection, recurrence and survival following LS and OS. Fixed and random effects models were used. Results Six RCTs enrolling 1033 participants (LS group:577 cases,OS group:456 cases)were included in the meta-analysis. Number of lymph node harvested was similar (WMD=-0.38,95% CI:-1.35-0.58,P=0.43). LS had a slightly higher circunfference resection margin (CRM) positive rate with no statistical significance [7.94% vs. 5.37%; risk ratio (RR)=1.13;95% CI:0.69-1.85,P=0.63]. There was no significant difference between the two groups in local recurrence (RR=0.55; 95% CI:0.22-1.40, P=0.21). The 3-year overall survival [Hazard ratio(HR)=0.76; 95% CI:0.54-1.07,P=0.11] and 3-year disease-free survival (HR=1.16; 95% CI:0.61-2.20,P=0.64) were not significantly different between the two groups. Conclusion Compared with open surgery, laparoscopic surgery of rectal carcinoma offers sinilar oncological clearance and long-term oncological outcomes.