经肛门全直肠系膜切除术在中低位直肠癌中的疗效及安全性的系统评价和Meta分析*

Clinical efficacy and safety of transanal total mesorectal excision for patients with middle and low rectal cancer: a systematic review and Meta-analysis*

摘要:

摘要：目的 系统评价经肛门全直肠系膜切除术（TaTME）在低位直肠癌中的疗效及安全性。方法 计算机检索各数据库The Cochrane Library、Pubmed、Embase、Web of Science、维普、万方、知网和中国生物医学文献数据库（CBM），收集所有关于对比TaTME与腹腔镜全直肠系膜切除术（LaTME）治疗中低位直肠癌疗效的相关研究。对于纳入文献依据NOS量表进行质量评价，采用Review Manager 5.3版软件进行数据合并。结果 共纳入13篇符合该研究的文献，共859例直肠癌患者。在疗效方面，Meta分析结果显示，与LaTME相比，TaTME提高了肿瘤完全切除的概率，减少了环周切缘阳性（CRM）的发生风险（OR=1.75，95%CI=1.02～3.01，P =0.040；OR=0.43，95%CI=0.22～0.82，P =0.010）。在安全性方面，Meta分析结果显示，两者的术后并发症相似，发生肠梗阻和吻合口漏的风险差异无统计学意义（OR=0.91，95%CI=0.46～1.78，P =0.780；OR=0.79，95%CI =0.45～1.38，P =0.400）。结论 TaTME在治疗中低位直肠癌患者的疗效方面比LaTME好，有效降低了肿瘤的CRM的发生率。但在安全性方面，两者没有较大的差异，其真实性还需大量高质量的研究进一步验证。

Abstract:

Abstract: Objective To evaluate the efficacy and safety of transanal total mesorectal excision (TaTME) for the rectal cancer. Methods The databases of Cochrane Library, PubMed, EMbase, Web of Science, CBM, CNKI, VPCS and WanFang Data. All the relevant studies were collected to evaluate the efficacy and safety of transanal total mesorectal excision (TaTME) for the rectal cancer. The quality of the included studies was assessed by the newcastle-ottawa quality assessment scale (NOS). Meta-analysis was conducted by Review Manager 5.3 software. Results 13 studies involving 859 patients were included. In terms of efficacy, Meta-analysis illustrated that TaTME increased the chance of complete resection of the tumor compared with LaTME and reduced the risk of positive circumferential margins. The OR value and 95%CI were (OR = 1.75, 95%CI = 1.02 ~ 3.01, P = 0.040) vs (OR = 0.43, 95%CI = 0.22 ~ 0.82, P = 0.010), respectively. And in terms of safety, the results of Meta analysis showed that the postoperative complications were similar and the risk of lleus and anastomotic leakage was not statistically significant. The Meta-results of them were (OR = 0.91, 95%CI = 0.46 ~ 1.78, P = 0.780) vs (OR = 0.79, 95%CI = 0.45 ~ 1.38, P = 0.400), respectively. Conclusion TaTME had better efficacy than LaTME for the patients with mid- or low-rectal cancer, effectively reducing the incidence of positive peripheral margin. But in terms of safety, there was no significant difference and its authenticity remains more high-quality researches to verify.