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目的研究完整结肠系膜切除术(CME)对比传统结肠癌根治术的安全性与优越性。方法利用计算机检索国内外著名数据库近5年内发表的关于CME与传统结肠癌根治术对比研究的文献,遵循严格的筛选标准,提取高质量文献的数据资料,用Review Manager5.3软件进行系统评价,最后分析结果。结果共检索出初始文献约500篇。根据纳入与排除标准逐篇查阅、分析和评价,最终决定纳入10项研究,其中5篇为英文文献,5篇为中文文献。总病例1 447例,其中CME组733例,传统手术组714例。(1)CME组的术中出血量明显少于传统手术组[WMD=-28.17,95%CI=-52.77~-3.57,P=0.02],而两组的手术时间差异无统计学意义[WMD=3.70,95%CI=-18.25~25.66,P=0.74];(2)在术后病理标本淋巴结检出数、平均切除结肠长度和系膜面积以及营养血管长度等方面,CME组均优于传统结肠癌手术组,P分别小于0.01、0.01、0.01和0.05;(3)两组在术后首次排气时间以及住院时间方面差异均无统计学意义(P=0.45,0.08);(4)实行CME并没有增加手术并发症发生率(P=0.89)。结论与传统结肠癌根治术相比,CME更加符合外科解剖和胚胎学理念,在未增加手术风险及术后并发症的前提下,达到了最大化的根治效果,安全、有效、可行,为结肠癌规范化的手术方式又增添了浓墨重彩的一笔。
Objective To investigate the safety and superiority of complete mesorectal excision (CME) versus conventional colon cancer. Methods Using computer to search the domestic and international well-known databases published in the past 5 years, the literature on the comparative study of CME and traditional colon cancer radical operation, follow the strict screening criteria, extract high-quality literature data, review the system with Review Manager5.3 software, The final analysis results. Results A total of about 500 original documents were retrieved. According to the inclusion and exclusion criteria, they were reviewed, analyzed and evaluated. Ten studies were finally selected, of which five were English and five were Chinese. There were 1 447 cases in total, including 733 cases in CME group and 714 cases in traditional operation group. (1) The intraoperative blood loss in CME group was significantly less than that in the conventional surgery group [WMD = -28.17, 95% CI = -52.77 ~ -3.57, P = 0.02], but there was no significant difference in operative time between the two groups [WMD = 3.70, 95% CI = -18.25 ~ 25.66, P = 0.74]. (2) The CME group was superior to the CME group in the number of postoperative pathological lymph nodes, the average length of colon resection and mesangial area and the length of vegetative vessels (P = 0.45, 0.08). (4) In the conventional colon cancer surgery group, P was less than 0.01, 0.01, 0.01 and 0.05 respectively. (3) There was no significant difference between the two groups in the time of the first extubation and the length of hospital stay CME did not increase the incidence of complications (P = 0.89). Conclusion Compared with traditional radical resection of colon cancer, CME is more in line with the concept of surgical anatomy and embryology, without increasing the risk of surgery and postoperative complications under the premise of achieving the maximum effect of radical, safe, effective and feasible for the colon The standardization of cancer surgery has added a touch of color.