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目的:评价直肠癌侧方淋巴结清扫术(lateral lymph node dissection,LLND)在直肠癌根治术中的价值。方法:检索国内外公开发表的有关直肠癌LLND的中文和英文文献,最终符合入选标准的文献共15篇,包含4858例患者,其中LLND组2401例,NLLND组(非LLND)2457例。评价指标包括5年生存率、复发率、围手术期情况以及术后泌尿系统功能和性功能情况等。结果:NLLND组的手术时间较LLND组明显缩短[加权均数差(weighted mean difference,WMD)为109min,95%可信区间(confidence interval,CI)为90~129,P<0.00001];LLND组的术中失血量大于NLLND组,但差异无统计学意义(WMD为429mL,95%CI为325~854,P=0.05);LLND组的围手术期并发症发生率明显高于NLLND组[比值比(odds ratio,OR)为1.57,95%CI为1.06~2.33,P=0.02]。LLND组与NLLND组的手术后5年生存率差异无统计学意义(OR为0.94,95%CI为0.78~1.12,P=0.48);LLND组与NLLND组总的手术后复发率差异无统计学意义(OR为0.92,95%CI为0.70~1.22,P=0.57)。此外,NLLND组发生泌尿系统功能障碍的可能性低于LLND组(OR为5.12,95%CI为2.15~12.19,P=0.0002);个别研究报道NLLND组男性患者的性功能障碍发生率低于LLND组(P<0.05)。结论:Meta分析结果显示,LLND组在降低术后复发率和延长生存期方面未显示出明显优势,但LLND组的围手术期并发症发生率有所增加、手术时间延长、手术出血量增加,术后性功能和泌尿系统功能障碍的发生率也均有所增加。
Objective: To evaluate the value of lateral lymph node dissection (LLND) in rectal cancer undergoing radical operation. METHODS: A total of 1558 published articles about LLND in Chinese and English published at home and abroad and finally meeting the inclusion criteria were included. Among them, 4858 were LLLL and 2457 were non-LLND. Evaluation indicators include 5-year survival rate, recurrence rate, perioperative conditions and postoperative urinary system function and sexual function. Results: The operative time of NLLND group was significantly shorter than that of LLND group (weighted mean difference (WMD) was 109 min, 95% confidence interval (CI) was 90 ~ 129, P <0.00001] (P <0.05). The incidence of perioperative complications in LLND group was significantly higher than that in NLLND group [the ratio was 429 mL (95% CI: 325-854, P = Odds ratio (OR) was 1.57, 95% CI 1.06-2.33, P = 0.02]. There was no significant difference in 5-year survival rate between LLND group and NLLND group (OR = 0.94, 95% CI: 0.78 to 1.12, P = 0.48). There was no significant difference in the total postoperative recurrence between LLND group and NLLND group Significance (OR 0.92, 95% CI 0.70-1.22, P = 0.57). In addition, the incidence of urinary dysfunction in the NLLND group was lower than that in the LLND group (odds ratio 5.12, 95% CI 2.15-12.19, P = 0.0002). Individual studies reported that the incidence of sexual dysfunction in male patients in the NLLND group was below LLND Group (P <0.05). Conclusion: The results of Meta analysis show that the LLND group has no obvious advantage in reducing the postoperative recurrence rate and prolonging the survival time. However, the incidence of perioperative complications in LLND group increases, the operation time prolongs, the operation bleeding volume increases, Postoperative sexual function and urinary system dysfunction have also increased the incidence.