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目的:通过分析对照试验结果,客观的评价右半结肠切除术中腹腔镜手术与传统开腹手术治疗结肠癌的疗效及安全性。方法:计算机检索数据库PubMed、EMBASE、Cochrane图书馆、CNKI、万方数据库等至2013年8月前,应用腹腔镜手术和传统开腹手术治疗右侧结肠癌的对照试验文献,并提取相关文献特征资料。制定文献纳入与排除标准,严格按照标准筛选文献,并对文献质量进行评估。使用RevMan 5.2软件进行分析组间加权均数差(Weighted Mean Difference,WMD)、优势比(Odds Ratio,OR)及95%可信区间(95%confidence interval,95%CI),并使用漏斗图检验发表偏倚。结果:共检索出文献647篇,最终纳入13篇文献,入选患者1338人,585人为观察组接受腹腔镜手术治疗,753人为对照组接受传统开腹手术治疗。Meta分析结果显示,腹腔镜手术与传统开腹手术相比,术中失血量降低[WMD=-108.83,95%Cl(-141.59,-76.07),P<0.00001],术后排气时间更早[WMD=-1.12,95%Cl(-1.43,-0.82),P<0.00001],住院时间减少[WMD=-4.45,95%Cl(-5.54,-3.35),P<0.00001],切口感染的风险降低[OR=0.51,95%Cl(0.28,0.91),P=0.02],同时手术时间延长[WMD=22.79,95%Cl(15.10,30.48),P<0.00001]。而两组间淋巴结捡取数、死亡率、复发率等没有明显统计学差异(P>0.05)。结论:对于结肠癌,腹腔镜手术行右半结肠切除术较传统开腹手术可提高短期疗效,尽管对于死亡率、复发率没有明显改善,但可以显著减少术中失血量、排气时间、住院时间以及切口感染的几率。
Objective: To evaluate the curative effect and safety of colorectal cancer in laparoscopic surgery and traditional laparotomy in right hemicolectomy by analyzing the results of controlled trials. METHODS: The controlled trials of laparoscopic and conventional laparotomy for right colon cancer were searched by computer search database PubMed, EMBASE, Cochrane Library, CNKI and Wanfang database until August 2013, and the related literatures were extracted data. Document inclusion and exclusion criteria, screen the literature strictly in accordance with the standards, and evaluate the quality of the literature. Weighted Mean Difference (WMD), odds ratio (OR) and 95% confidence interval (95% confidence interval) were analyzed using RevMan 5.2 software, Post bias. Results: A total of 647 articles were retrieved and 13 articles were finally enrolled. Among them, 1338 were enrolled, 585 were treated by laparoscopy in the observation group and 753 were controlled by traditional laparotomy. Meta-analysis showed that laparoscopic surgery compared with conventional laparotomy, intraoperative blood loss decreased [WMD = -108.83,95% Cl (-141.59, -76.07), P <0.00001], postoperative exhaust time earlier [WMD = -1.12,95% Cl (-1.43, -0.82), P <0.00001], hospital stay decreased [WMD = -4.45,95% Cl (-5.54, -3.35), P <0.00001] Risk decreased [OR = 0.51, 95% Cl (0.28, 0.91), P = .02], while the operative time was prolonged [WMD = 22.79,95% Cl (15.10,30.48), P <0.00001]. No significant difference was found in the number of lymph nodes, mortality and recurrence between the two groups (P> 0.05). Conclusions: For colon cancer and laparoscopic surgery, right-hemicolectomy may improve the short-term curative effect compared with the traditional laparotomy. Although there is no significant improvement in the recurrence rate for mortality, the laparoscopic surgery can significantly reduce the intraoperative blood loss, exhaust time, hospitalization Time and incision infection chances.