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目的比较腹腔镜与开腹全直肠系膜切除术治疗直肠癌的临床疗效。方法计算机检索PubMed、EMBASE、Cochrane Library、CNKI、万方、维普等数据库2010年9月1日至2015年9月1日期间公开发表的腹腔镜与开腹全直肠系膜切除术的随机对照研究,2位评价者按纳入排除标准独立完成文献筛选,交叉审核,提取相关结局指标数据,应用RenMan 5.1软件进行Meta分析。结果最终纳入10篇对照研究,总病例数2820例,腹腔镜全直肠系膜切除术(1aparoscopic total mesorectal excision,LTME)组1595例,开腹全直肠系膜切除术(open total mesorectal excision,OTME)组1225例。围手术期相关指标:LTME组手术时间较OTME组长30.34 ml,LTME组术中出血量较OTME组少78.26 ml,LTME组术后肛门首次通气时间平均短1.13天,LTME组术后平均住院时间平均短2.60天,同时LTME组术后切口感染发生率更低。而LTME组与OTME组淋巴结清扫数,环切缘阳性例数,吻合口瘘、肠梗阻发生率比较,差异均无统计学意义。预后相关研究指标:LTME组与OTME组3年局部复发、3年总生存率、3年无病生存率(DFS)、5年OS、5年DFS比较,差异均无统计学意义。结论LTME治疗直肠癌短期疗效优势明显,术中出血少,肛门通气时间早,术后平均住院时间短,切口感染发生率低。二者远期疗效比较LTME组不亚于OTME组。
Objective To compare the clinical efficacy of laparoscopic and open mesorectal excision in the treatment of rectal cancer. Methods A computer-controlled randomized controlled trial of laparoscopic and open total mesorectal excision was performed on PubMed, EMBASE, Cochrane Library, CNKI, Wanfang, Vipu and other databases from September 1, 2010 to September 1, 2015. Two reviewers independently screened the documents according to inclusion criteria, cross-examined them, and extracted relevant outcome data. Meta-analysis was performed using RenMan 5.1 software. Results A total of 10 controlled trials were enrolled in the study. The total number of cases was 2820 cases, 1595 cases of laparoscopic total mesorectal excision (LTME), 1225 cases of open total mesorectal excision (OTME) example. Perioperative related indicators: LTME group operation time than the OTME group leader 30.34 ml, LTME group less blood loss than the OTME group 78.26 ml, LTME group postoperative anal first average short time of 1.13 days, LTME group average postoperative hospital stay Average 2.60 days shorter, while LTME group postoperative incision infection incidence is lower. However, there was no significant difference in the number of lymph node dissection, the number of circumcision margin positive cases, anastomotic fistula and intestinal obstruction between LTME group and OTME group. Prognostic indicators: There was no significant difference in 3-year local recurrence, 3-year overall survival, 3-year disease-free survival (DFS), 5-year OS, and 5-year DFS between LTME group and OTME group. Conclusion LTME has obvious short-term curative effect in treating rectal cancer with less bleeding during operation, earlier anus ventilation, shorter average postoperative hospital stay, and lower incidence of incisional infection. The long-term efficacy of both LTME group compared with the OTME group.