腹腔镜下腹部无切口结直肠癌切除对比传统腹腔镜下结直肠癌切除可行性和安全性的Meta分析

发布时间：2018-03-13 02:31

本文选题：结直肠癌　切入点：腹腔镜　出处：《中南大学学报(医学版)》2017年01期 　论文类型：期刊论文

【摘要】：目的:评价腹腔镜下腹部无切口结直肠癌切除术较之传统腹腔镜下结直肠癌切除术的可行性和安全性。方法:检索2005年8月至2015年8月公开发表的腹腔镜下腹部无切口结直肠癌切除对比传统腹腔镜下结直肠癌切除术应用情况的文献。按纳入标准筛选后进行质量评分,提取临床效应指标,采用Review Maneger 5.3软件对所纳入的数据进行Meta分析。结果:最终纳入7项研究,共621例患者,其中无辅助切口组(NOSE组)262例,传统腹腔镜组(LAP组)359例。Meta分析结果显示总并发症发生率的对比NOSE组明显较LAP组少(OR=0.31,95%CI:0.18~0.53,P0.05)。对并发症进行亚组分析,其中切口并发症NOSE组较LAP组少(OR=0.15,95%CI:0.05~0.40,P=0.0002);术后出血(OR=1.52,95%CI:0.38~6.18,P=0.55)、肠梗阻(OR=0.30,95%CI:0.09~0.98,P=0.05)、吻合口相关并发症(OR=0.92,95%CI:0.28~3.07,P=0.89)、其他相关并发症(OR=0.63,95%CI:0.23~1.66,P=0.35)等亚组两组比较差异无统计学意义;住院时间(MD= 0.66,95%CI: 1.33~0.01,P=0.05)、手术持续时间(MD=14.78,95%CI: 1.75~31.31,P=0.08)、术中出血量(MD= 12.81,95%CI: 40.36~14.74,P=0.36)、切除肿瘤大小(SMD= 0.40,95%CI: 0.87~0.08,P=0.10)、淋巴结清扫(MD= 0.49,95%CI:1.80~0.82,P=0.46)、随诊2年肿瘤复发(OR=1.15,95%CI:0.38~3.50,P=0.81)等指标NOSE组与LAP组比较差异均无统计学意义;术后肛门首次排气时间(SMD= 0.62,95%CI: 0.82~ 0.42,P0.001)及术后恢复进食时间(SMD= 0.60,95%CI: 1.15~ 0.05,P=0.03)NOSE组均较LAP组更早;术后疼痛指数(MD= 1.49,95%CI: 1.97~ 1.01,P0.001)NOSE组较LAP组明显较低;且NOSE组具有更好的美容效果(MD=1.37,95%CI:0.59~2.14,P=0.0005)。结论:腹腔镜辅助腹部无辅助切口结直肠癌切除可显著减少患者切口并发症的发生,并可减轻患者疼痛,加快术后恢复,具有更好的美容效果,是治疗结直肠癌安全、可行、有效的方法。
[Abstract]:Objective: to evaluate the feasibility and safety of laparoscopic laparoscopic resection of colorectal cancer without incision compared with traditional laparoscopic resection of colorectal cancer. Literature on the application of non-incisional resection of colorectal cancer to conventional laparoscopic resection of colorectal cancer. The clinical effect indexes were extracted and analyzed by Meta with Review Maneger 5.3 software. Results: a total of 621 patients were included in 7 studies, including 262 cases in the no assistant incision group. The results of Meta-analysis showed that the incidence of total complications in the NOSE group was significantly lower than that in the LAP group, and the incidence of complications in the NOSE group was significantly lower than that in the LAP group. The complications of incision in the NOSE group were less than those in the LAP group. The complications of incision in NOSE group were less than those in LAP group. There was no significant difference between the two groups, such as the group of postoperative bleeding: 1.5295 CI: 0.382.95CI0.386.18P0.55, the group of intestinal obstruction: 0.090.98P0.05, the complication of anastomosis: 0.28295 CIW 0.283.03.0P0.89.The other related complications were 0.6395CI0.231.66P0.35. there was no significant difference between the two groups. The duration of hospitalization was 1.330.01P0.05C, and the duration of operation was 1.7531.31P0.08. The amount of intraoperative bleeding was 40.3614.74P0.360.3614.74P0.36CI.There was no significant difference between the NOSE group and the LAP group, and there was no significant difference between the NOSE group and the LAP group. The time of the first exsufflation of anus after operation (SD = 0.62 ~ 0.42% P0.001) and the time of recovery of food after operation were 1.15 ~ 0.05 ~ 0.05 and 0.03% respectively earlier than those in the LAP group, and the postoperative pain index (MD = 1.4995 CI: 1.971P 0.001) was significantly lower than that in the LAP group. The postoperative pain index of the two groups was significantly lower than that of the LAP group, and the postoperative pain index of the two groups was significantly lower than that of the LAP group (P < 0.05). The postoperative pain index of the two groups was significantly lower than that of the LAP group. The postoperative pain index of the two groups was significantly lower than that of the LAP group. And NOSE group has better cosmetic effect. Conclusion: laparoscopic assisted abdominal resection of colorectal cancer can significantly reduce the incidence of incision complications, alleviate pain and accelerate postoperative recovery, and has a better cosmetic effect. It is a safe, feasible and effective method for the treatment of colorectal cancer.
【作者单位】：新钢中心医院普外1科;南昌大学第二附属医院胃肠外科;
【分类号】：R735.34

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