直肠癌腹腔镜与开腹全直肠系膜切除术术后吻合口漏发生率比较的Meta分析
Incidence of postoperative anastomotic leakage of laparoscopic versus open total mesorectal excision for rectal cancer:A meta-analysis
廖刚 1王子卫 1李革 2张能 1帅磊渊 1唐喜1
作者信息
- 1. 重庆医科大学附属第一医院胃肠外科,重庆,400016
- 2. 重庆医科大学公共卫生学院流行病学教研室,重庆,400016
- 折叠
摘要
目的:探讨腹腔镜的应用是否会对全直肠系膜切除术(TME)术后吻合口漏发生率造成影响.方法:全面检索中、英文献,收集腹腔镜全直肠系膜切除术(LTME)与开腹全直肠系膜切除术(OTME)术后吻合口漏发生率比较的随机对照试验(RCT)、临床对照试验和病例系列.由两名作者独立评价文献,采用RevMan5.0.2.0软件进行Meta分析.结果:共纳入3项个体RCT,2项个体病例对照研究和13项病例系列.纳入研究存在方法学异质性,根据纳入研究的方法学类型进行亚组分析,亚组内无统计学异质性,采用固定效应模型进行合并分析.LTME与OTME术后吻合口漏发生率差异无统计学意义(P=0.60),合并比值比(OR)及其95%可信区间(95%CI)为0.90(0.60,1.34).结论:腹腔镜的应用不会对TME吻合口漏发生率造成影响.然而由于是在缺乏足够数量的RCT的情况下,纳入部分分级为3 b和4的非随机对照试验的Meta分析,使论证强度受到一定的限制,有待更多大样本高质量RCT结果的进一步验证.
Abstract
AIM: To explore whether the application of laparos-copy to total mesorectal excision increase the incidence of postoperative anastomotic leakage. METHODS: Literatures of randomized controlled trials ( RCT),controlled clinical trials and case series in Chinese and English relative to the incidence of postoperative anastomotic leakage of laparoscopic total mesorectal excision (LTME) versus open total mesorectal excision(OTME) for rectal cancer were searched for. Literatures were evaluated and data were screened by two authors independently and RevMan5.0.2.0 software was used for meta-analysis. RESULTS: Three individual RCT,2 individual case-control studies and 13 case-series were included. Considering the methodological heterogeneity of the included trials,we classified the samples by the methodologies employed in the trials. As no statistical heterogeneity of the methodologies used was seen in the subgroups,fixed effect model was used to analyze the overall effect. There was no statistical difference in the incidence of postoperative anastomotic leakage between the two groups (P = 0. 60) and the pooled odds ralio( OR) was 0.90(95% confidence interval,95% CI,0. 60 to 1.34). CONCLUSION: The application of laparoscopy to TME will not increase the incidence of postoperative anastomotic leakage. But the results of our study have some limitations due to nonrandom-ized controlled trials with grade 3 b and 4 included in the study and the relatively small-sized RCT samples. More RCTs with a large sample size are needed to further confirm the results.
关键词
直肠肿瘤/腹腔镜全直肠系膜切除术/开腹全直肠系膜切除术/吻合口漏/Meta分析Key words
rectal neoplasms/laparoscopic total mesorectal excision/open total mesorectal excision/anastomotic leakage/Meta-analysis引用本文复制引用
出版年
2009
NETL
NSTL
维普
万方数据