论文部分内容阅读
目的系统评价分析腹腔镜与开腹结肠癌完整结肠系膜切除术的疗效。方法采用Meta分析法,检索中英文数据库中相关的临床试验,最终入选6篇文章,提取筛选后的文献资料,内容包括一般资料、治疗方法、观察指标以及结果与结论 ,采用Jadad量表法评价文献质量,并进行综合定量Meta分析。结果最终纳入6篇文献,746例随机对照患者,腹腔镜组390例,开腹组356例。6篇文献中2篇为低质量,4篇为高质量,文献的Jadad量表评分依次为3、2、2、3、3、3分。6篇文献的手术时间、术中出血量、术后肛门排气时间、住院时间均存在明显异质性(I2=75%、98%、94%、67%),应用随机效应模型进行Meta分析,结果显示:两组的手术时间比较差异无统计学意义[WMD=-4.67,95%CI=(-0.95,10.29),P>0.05],腹腔镜组的术中出血量明显少于开腹组[WMD=-23.09,95%CI=(-36.87,-9.31),P<0.05],腹腔镜组的肛门排气时间明显短于开腹组[WMD=-0.89,95%CI=(-1.21,-0.57),P<0.05],腹腔镜组的住院时间明显短于开腹组[WMD=-2.82,95%CI=(-3.73,-1.91),P<0.05]。6篇文献的术后并发症无明显异质性(I2=0)应用固定效应模型进行Meta分析,结果显示:腹腔镜组的术后并发症明显少于开腹组[OR=0.52,95%CI=(0.36,0.76),P<0.05]。采用同样的方法进行分析,两组复发率、存活率、切除结肠长度、淋巴结检出数目以及阳性淋巴结检出数目比较差异无统计学意义(P>0.05)。结论腹腔镜结肠癌完整结肠系膜切除术的疗效优于开腹手术,具有术中出血量少、术后肛门排气时间与住院时间短、术后并发症发生率低等优势,可推荐开展。
Objective To evaluate the efficacy of laparoscopic and open colon mesenteric resection of open colon cancer. Methods Meta-analysis was used to search the related clinical trials in Chinese and English databases. Finally, 6 articles were selected, and the selected documents were extracted, including general information, treatment methods, observation indexes and results and conclusions. The Jadad scale Literature quality, and a comprehensive quantitative meta-analysis. The results were finally included in the 6 articles, 746 cases of randomized controlled patients, 390 cases of laparoscopic group, 356 cases of open group. Two of the six articles were of low quality and four of them were of high quality. The Jadad scale scores of the literature were 3, 2, 2, 3, 3 and 3 respectively. There were significant heterogeneity of operation time, intraoperative blood loss, postoperative anal exhaust time and hospitalization time in all the 6 articles (I2 = 75%, 98%, 94%, 67%). Meta-analysis The results showed that there was no significant difference in operation time between the two groups [WMD = -4.67,95% CI = (-0.95, 10.29), P> 0.05]. The intraoperative blood loss in laparoscopic group was significantly less than that in open group The anal exhaust time in laparoscopic group was significantly shorter than that in open group [WMD = -0.32, 95% CI = (--36.87, -9.31, P < 1.21, -0.57), P <0.05]. The length of stay in laparoscopic group was significantly shorter than that in open group [WMD = -2.82,95% CI = (-3.373, -1.91), P <0.05]. There was no significant heterogeneity in the postoperative complications of 6 articles (I2 = 0). Meta-analysis was performed using the fixed effect model. The postoperative complications in the laparoscopic group were significantly less than those in the open group [OR = 0.52, 95% CI = (0.36, 0.76), P <0.05]. The same method was used to analyze. The recurrence rate, survival rate, the length of resected colon, the number of lymph nodes and the number of positive lymph nodes were not significantly different between the two groups (P> 0.05). Conclusions Laparoscopic colon mesenteric resection is superior to laparotomy in complete mesorectal excision. It has the advantages of less intraoperative blood loss, shorter postoperative anal exhaust time and hospital stay, and lower postoperative complications.