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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Rev Man 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。
Objective: To evaluate the clinical efficacy of hand assisted laparoscopic surgery (HALS) and laparoscopic assisted surgery (LAS) in the treatment of colorectal cancer. Methods: A computer-based search of multiple databases at home and abroad was conducted to collect randomized controlled trials and non-randomized controlled trials comparing the efficacy of HALS with LAS in the treatment of colorectal cancer. The quality scores were screened and screened based on the inclusion criteria. Data were extracted and analyzed using Rev Man 5.3 software Meta analysis. RESULTS: Twenty-seven studies were eventually enrolled in a total of 3 347 patients, including 1 626 in the HALS group and 1 721 in the LAS group. The results of Meta analysis showed that the operative time of HALS group was shorter (WMD = -24.18, 95% CI = -31.61 ~ -16.75), transition rate (OR = 0.57, 95% CI = 0.41-0.81) (OR = 0.48, 95% CI = 0.29 ~ 0.78), less Trocar but longer incision length (WMD = 1.07,95% CI = 0.64-1.50), the difference was statistically significant ). There was no significant difference between the two groups in postoperative recovery, postoperative complications, oncology index, follow-up results, postoperative pain and hospitalization costs (all P> 0.05). Conclusions: HALS combines the intuitive advantages of minimally invasive and open laparoscopic surgery with LAS and is an option for minimally invasive surgery for colorectal cancer.