腹腔镜与开腹低位直肠癌保肛术安全性的Meta分析

Meta-analysis of safety in laparoscopic and open surgery for preserving anus in low rectal cancer

摘要:

目的 分析腹腔镜与传统开腹手术在低位直肠癌保肛术中的安全性。方法 按照拟定的标准，筛选出13篇比较腹腔镜与开腹术式在低位直肠癌保肛治疗中安全性的文献，运用Meta分析对相关临床指标进行综合分析。结果 开腹组（OS组）的手术时间较腹腔镜组（LS组）少16.86 min（MD = 16.86，95%CI：9.74～23.98，P = 0.000）、术中出血量较LS组多115.16 mL（MD = -115.16，95%CI：-141.90～-88.42，P = 0.000）。两组术中清扫的淋巴结数目比较，差异无统计学意义（MD = 0.03，95%CI：-0.66～0.72，P = 0.930）。LS组环周切缘（CRM）癌肿的阳性率较OS组高（O = 2.67，95%CI：1.07～6.68，P = 0.040）。LS组术后切口并发症发生率比OS组低（O = 0.20，95%CI：0.08～0.50，P = 0.001）。两组术后吻合口瘘、肠梗阻和泌尿系并发症发生率比较，差异无统计学意义（均P > 0.05）。LS组术后肛门首次排气时间较OS组早（SMD = -1.61，95%CI：-2.20～-1.01，P = 0.000）、住院时间较OS组短2.78 d（MD = -2.78，95%CI：-3.84～-1.71，P = 0.000）。两组术后肿瘤局部复发率和远处转移率比较，差异无统计学意义（均P > 0.05）。结论 与OS比较，LS在低位直肠癌保肛术中对患者损伤小、术后恢复快。两种术式在肿瘤的安全性上无明显区别。

Abstract:

Objective To compare the safety in laparoscopic and traditional laparotomy for anus-preserving radical resection in low rectal cancer.Methods According to the established criteria, 13 literatures were screened to compare the safety of laparoscopic and laparotomy in anus-preserving treatment of low rectal cancer. Meta-analysis method was used to comprehensively analyze the relevant clinical indicators.Results The operation time in open surgery group was 16.86 min shorter than that in laparoscopic surgery group (MD = 16.86, 95% CI: 9.74～23.98, P = 0.000), and the intraoperative blood loss was 115.16 mL higher than that in LS group (MD = -115.16, 95%CI: -141.90～88.42, P = 0.000). There was no significant difference in the number of lymph nodes dissected between the two groups (MD = 0.03, 95%CI: -0.66～0.72, P = 0.930). The positive rate of circumferential margin cancer in laparoscopic surgery group was higher than that in open surgery group (O = 2.67, 95%CI: 1.07～6.68, P = 0.040). The incidence of incision-related complications in laparoscopic surgery group was smaller than that in open surgery group, the difference between the two groups was statistically significant (O = 0.20, 95% CI: 0.08～0.50, P = 0.001). In the incidence of anastomotic leakage, intestinal obstruction and urinary complications after operation between the two groups, the differences were not statistically significant (all P > 0.05). The first time of anal exhaust in laparoscopic surgery group was earlier than that in open surgery group (SMD =-1.61, 95%CI: -2.20～-1.01, P = 0.000) and the hospital stay in laparoscopic surgery group was 2.78 d less than that in open surgery group (MD = -2.78, 95%CI: -3.84～-1.71, P = 0.000). There was no significant difference in local recurrence rate and distant metastasis rate between the two groups (all P > 0.05).Conclusion Laparoscopic surgery in the anus-preserving surgery for low rectal cancer has less injury and faster recovery than open surgery. There was no significant difference between the two methods in safety.