专题研究(Monographic Study)

手助腹腔镜手术与腹腔镜手术治疗结直肠癌的Meta分析

Published at: 2016年第25卷第4期

王国森 1 , 周建平 1 , 盛伟伟 1 , 董明 1
1 中国医科大学第一附属医院 胃肠外科,辽宁 沈阳 110001
通讯作者 建平 周 Email: zjphama@163.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2016.04.007
基金:
辽宁省沈阳市科技局社发基金资助项目 F14-158-9-35

摘要

目的:系统评价手辅助腹腔镜手术(HALS)与腹腔镜辅助手术(LAS)治疗结直肠癌的临床疗效。方法:计算机检索国内外多个数据库,收集有关比较HALS与LAS治疗结直肠癌疗效的随机对照试验与非随机对照研究,按纳入标准筛选后进行质量评分,提取数据,采用RevMan 5.3软件行Meta 分析。结果:最终纳入27篇研究,共3 347例患者,其中HALS组1 626例,LAS组1 721例。Meta分析结果显示,与LAS组比较,HALS组手术时间短(WMD=-24.18,95% CI=-31.61~-16.75)、中转率(OR=0.57,95% CI=0.41~0.81)和术中损伤率低(OR=0.48,95%CI=0.29~0.78)、使用Trocar少,但切口长度增加(WMD=1.07,95% CI=0.64~1.50),差异均有统计学意义(均P<0.05)。两组在术后恢复、术后并发症、肿瘤学指标、随访结果、术后疼痛以及住院费用等方面的差异均无统计学意义(均P>0.05)。结论:HALS结合了LAS微创和开腹手术直观的优点,可作为结直肠癌微创手术的一个选择。


Hand-assisted laparoscopic surgery versus laparoscopic-assisted surgery for colorectal cancer: a Meta-analysis

Abstract

Objective: To systematically assess the clinical efficacy of hand-assisted laparoscopic surgery (HALS) and laparoscopic-assisted surgery (LAS) in treatment of colorectal cancer. Methods: The randomized controlled trials and non-randomized comparative studies comparing HALS and LAS for colorectal cancer were collected by searching several national and international databases. After screening for inclusion, quality assessment and data extraction, Meta-analysis was performed by the RevMan 5.3 software. Results: A total of 27 studies involving 3 347 patients were finally included, with 1 626 cases in HALS group and 1 721 cases in LAS group. Results of Meta-analysis showed that in HALS group compared with LAS group, the operative time (WMD=–24.18, 95% CI=–31.61––16.75) was shortened, conversion rate (OR=0.57, 95% CI=0.41–0.81) and incidence of intraoperative injuries (OR=0.48, 95% CI=0.29–0.78) were decreased, the number of trocars used was reduced, but the length of incision (WMD=1.07, 95% CI=0.64–1.50) was increased, and all differences had statistical significance (all P<0.05). There was no statistically significant difference between the two groups in terms of postoperative recovery, incidence of postoperative complications, oncological outcomes, follow-up results, postoperative pain and hospitalization costs (all P>0.05). Conclusion: HALS can be considered as an alternative for colorectal cancer, which combines the advantages of minimal invasiveness of LAS and direct view of open surgery.


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引用

引用本文: 国森 王, 建平 周, 伟伟 盛, 明 董. 手助腹腔镜手术与腹腔镜手术治疗结直肠癌的Meta分析 [J]. 中国普通外科杂志, 2016, 25(4): 497-509.
Cite this article as: WANG Guosen, ZHOU Jianping, SHENG Weiwei, DONG Ming . Hand-assisted laparoscopic surgery versus laparoscopic-assisted surgery for colorectal cancer: a Meta-analysis[J]. Chin J Gen Surg, 2016, 25(4): 497-509.