中国医师杂志
中國醫師雜誌
중국의사잡지
JOURNAL OF CHINESE PHYSICIAN
2014年
5期
638-642
,共5页
腹腔镜检查%肠系膜/外科学%直肠肿瘤/外科学%Meta分析%回顾性研究
腹腔鏡檢查%腸繫膜/外科學%直腸腫瘤/外科學%Meta分析%迴顧性研究
복강경검사%장계막/외과학%직장종류/외과학%Meta분석%회고성연구
Laparoscopy%Mesentery/surgery%Rectal neoplasms/surgery%Meta-analysis%Retrospective studies
目的 评价国内腹腔镜下行全直肠系膜切术(TME)治疗直肠癌的近期疗效.方法 系统检索2003年1月至2013年10月公开发表的腹腔镜与开腹TME手术治疗直肠癌的随机对照研究或设计良好的回顾性分析研究,由2名评价员独立筛选并提取数据资料,对符合纳入标准的研究使用Revman 5.2软件进行统计分析.结果 按照筛选标准,共计17篇随机对照实验(RCT),3篇回顾性病例分析纳入研究,病例总数2246例.腹腔镜手术(LS)组与开腹手术(OS)组患者一般情况及病历特征分布均衡.结果显示,与OS组相比,LS组术后切口感染(RR =0.30,95％ CI:0.17 ～0.54,P＜0.01)、肺部感染(RR=0.47,95％ CI:0.25～0.91,P＜0.05)以及肠梗阻发生率(RR =0.41,95％ CI:0.19 ～0.88,P＜0.05)均明显降低,而腹腔脓肿(RR=0.78,95％ CI:0.38～1.60,P＞0.05)、吻合口瘘(RR=0.66,95％ CI:0.38 ～ 1.16,P＞0.05)及尿潴留(RR=0.57,95％ CI:0.26～ 1.25,P＞0.05)并发症的发生率两组之间差异无统计学意义(P＞0.05).另外,在术后恢复的各项参数比较中,LS组均优于OS组(P＜0.01).结论 腹腔镜实施TME手术治疗直肠癌具有创伤小、术后恢复快、并发症少的特点,安全可行,极具前景.
目的 評價國內腹腔鏡下行全直腸繫膜切術(TME)治療直腸癌的近期療效.方法 繫統檢索2003年1月至2013年10月公開髮錶的腹腔鏡與開腹TME手術治療直腸癌的隨機對照研究或設計良好的迴顧性分析研究,由2名評價員獨立篩選併提取數據資料,對符閤納入標準的研究使用Revman 5.2軟件進行統計分析.結果 按照篩選標準,共計17篇隨機對照實驗(RCT),3篇迴顧性病例分析納入研究,病例總數2246例.腹腔鏡手術(LS)組與開腹手術(OS)組患者一般情況及病歷特徵分佈均衡.結果顯示,與OS組相比,LS組術後切口感染(RR =0.30,95％ CI:0.17 ～0.54,P＜0.01)、肺部感染(RR=0.47,95％ CI:0.25～0.91,P＜0.05)以及腸梗阻髮生率(RR =0.41,95％ CI:0.19 ～0.88,P＜0.05)均明顯降低,而腹腔膿腫(RR=0.78,95％ CI:0.38～1.60,P＞0.05)、吻閤口瘺(RR=0.66,95％ CI:0.38 ～ 1.16,P＞0.05)及尿潴留(RR=0.57,95％ CI:0.26～ 1.25,P＞0.05)併髮癥的髮生率兩組之間差異無統計學意義(P＞0.05).另外,在術後恢複的各項參數比較中,LS組均優于OS組(P＜0.01).結論 腹腔鏡實施TME手術治療直腸癌具有創傷小、術後恢複快、併髮癥少的特點,安全可行,極具前景.
목적 평개국내복강경하행전직장계막절술(TME)치료직장암적근기료효.방법 계통검색2003년1월지2013년10월공개발표적복강경여개복TME수술치료직장암적수궤대조연구혹설계량호적회고성분석연구,유2명평개원독립사선병제취수거자료,대부합납입표준적연구사용Revman 5.2연건진행통계분석.결과 안조사선표준,공계17편수궤대조실험(RCT),3편회고성병례분석납입연구,병례총수2246례.복강경수술(LS)조여개복수술(OS)조환자일반정황급병력특정분포균형.결과현시,여OS조상비,LS조술후절구감염(RR =0.30,95％ CI:0.17 ～0.54,P＜0.01)、폐부감염(RR=0.47,95％ CI:0.25～0.91,P＜0.05)이급장경조발생솔(RR =0.41,95％ CI:0.19 ～0.88,P＜0.05)균명현강저,이복강농종(RR=0.78,95％ CI:0.38～1.60,P＞0.05)、문합구루(RR=0.66,95％ CI:0.38 ～ 1.16,P＞0.05)급뇨저류(RR=0.57,95％ CI:0.26～ 1.25,P＞0.05)병발증적발생솔량조지간차이무통계학의의(P＞0.05).령외,재술후회복적각항삼수비교중,LS조균우우OS조(P＜0.01).결론 복강경실시TME수술치료직장암구유창상소、술후회복쾌、병발증소적특점,안전가행,겁구전경.
Objective To investigate the clinical short-term outcomes after laparoscopic total mesorectal excision (TME)for rectal cancer in China.Methods A systematic literature searching was performed to identify all randomized controlled trial(RCT) studies or well-designed retrospective studies on laparoscopic surgery(LS) and open surgery(OS) for rectal cancer published from January 2003 to October 2010 in China.Two reviewers independently screened and extracted the data.The reports which matched the inclusion criteria were analyzed with Revman 5.2.Results A total of 17 RCT studies and 3 retrospective studies (2246 patients)was included in this study.The basic features of 2 groups were balance.Compared to group OR,the incidence of complications such as postoperative wound infection (RR =0.30,95 ％ CI:0.17 ～0.54,P ＜ 0.01),pulmonary infection (RR =0.47,95％ CI:0.25 ～0.91,P ＜0.05),and ileus (RR =0.41,95％ CI:0.19 ～0.88,P ＜0.05)were significantly lower in group LS.No difference was observed in the incidence of peritoneal abscess(RR =0.78,95％ CI:0.38 ～ 1.60,P ＞0.05),anastomotic leakage(RR =0.66,95％ CI:0.38 ～ 1.16,P ＞0.05),and uroschesis(RR =0.57,95％ CI:0.26 ～ 1.25,P ＞0.05).Furthermore,parameters of postoperative recovery were compared between groups,LS group manifested early recovery.Conclusions Laparoscopic total mesorectal excision for rectal cancer,with minimal invasion,benefits the postoperative recovery and reduces incidence of complications.LS radical resection of rectal cancer is technically feasible,safe,and prospectively favorable.
