经肛提肌外腹会阴联合切除术与传统腹会阴联合切除术在低位直肠癌根治术中优越性比较的Meta分析

发布时间：2018-06-06 05:22

本文选题：低位直肠癌 + 经肛提肌外腹会阴联合切除术　；参考：《中南大学学报(医学版)》2017年03期

【摘要】：目的:经肛提肌外腹会阴联合切除术(extralevator abdominoperineal excision,ELAPE)治疗低位直肠癌可提高手术安全性和生存率仍存在争议。用Meta分析比较ELAPE与传统腹会阴联合切除术(conventional abdominoperineal excision,APE)在低位直肠癌根治术中的优越性。方法:在线检索Pub Med,Embase和Cochrane Library以及中国生物医学文献数据库、相关期刊论文和万方数字化期刊全文数据库中ELAPE组与APE组术中穿孔率,切缘阳性率,局部复发率,术后并发症等相关的病例对照研究或队列研究,采用Ren Man 5.2软件对入选研究进行Meta分析。结果:共纳入10篇文献,ELAPE组术中穿孔率(MD=0.54,95%CI:0.31~1.39,P=0.03)和局部复发率(MD=0.30,95%CI:0.21~0.42,P0.001)明显低于APE组。两组切缘阳性率(P=0.07)的差异无统计学意义。结论:通过会阴缺口的修补和个体化治疗可以改善ELAPE组术后生活质量。ELAPE术式治疗低位直肠癌较APE术式有一定优势,但应注重个体化治疗。同时建议开展大样本、多中心、中长期的随机对照研究,明确该术式的肿瘤学效果。
[Abstract]:Objective: to improve the safety and survival rate of low rectal cancer by transanal levator abdominoperineal excision combined with perineum excision. Meta analysis was used to compare the advantages of ELAPE and conventional abdominoperineal excision in radical resection of low rectal cancer. Methods: Pub Medembase and Cochrane Library, Chinese biomedical literature database, Chinese periodical full-text database and Wanfang digital periodical full-text database were searched online. The perforation rate, the positive rate of incision margin and the local recurrence rate of ELAPE group and APE group were analyzed. Ren Man 5.2 software was used to analyze the Meta of the selected patients in the case-control study or cohort study related to postoperative complications. Results: the intraoperative perforation rate and the local recurrence rate in the ELAPE group were significantly lower than those in the APE group. There was no significant difference in the positive rate of incision margin between the two groups (P < 0. 07). Conclusion: the repair of perineum notch and individualized treatment can improve the quality of life after operation in ELAPE group. ELAPE is superior to APE in treating low rectal cancer, but individualized treatment should be paid attention to. At the same time, it is suggested that a large sample, multi-center, long-term randomized controlled study be carried out to determine the oncology effect of this procedure.
【作者单位】：南昌大学第二附属医院胃肠外科;
【基金】：江西省卫生厅科技计划(20113046)~~
【分类号】：R735.37

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