目的:系统评价老年人腹腔镜直肠癌根治术中保留左结肠动脉是否安全有效.方法:检索PubMed、EMBase、Cochrane图书馆、Web of Science、万方、VIP、CNKI等数据库,文献检索从建库至2023年6月.对纳入文献进行质量评价和数据提取,应用stata16.0软件进行Meta分析.结果:纳入了 11篇文献,共1 138例患者,其中保留左结肠动脉(LCA)组571例,不保留LCA组567例.与对照组相比,保留LCA组住院时间(WMD=-0.844,95％CI=-1.064～-0.624,P＜0.05)、吻合口瘘的发生率(RR=0.274,95％CI=0.149～0.504,P＜0.05)、IMA 根部淋巴结清扫数目(WMD=-0.264,95％CI=-0.365～-0.163,P＜0.05)、术后排气时间(WMD=-0.364,95％CI=-0.669～-0.058,P＜0.05)均优于不保留组,但手术时间(WMD=9.518,95％CI=4.568～14.468,P＜0.05)与术中出血率高于不保留LCA组(RR=3.239,95％CI=1.901～4.578),P＜0.05);对于切口 感染率(RR=1.022,95％CI=0.411,2.545,P=0.962)、总淋巴结的清扫数目(WMD=0.226,95％CI=-0.714～1.167,P=0.637)、肠梗阻发生率(RR=0.708,95％CI=0.262～1.915,P=0.497)复发率(RR=1.183,95％CI=0.265～5.278,P=0.826)、吻合口 出血率(RR=0.979,95％CI=0.468～2.048,P=0.956)、尿潴留发生率(RR=0.633,95％CI=0.363～1.104,P=0.107)无显著差异.结论:保留左结肠动脉在住院时间、IMA根部淋巴结清扫数目、吻合口瘘发生率会优于不保留组;手术时间、术中出血率、术后排气时间却高于不保留LCA组;切口感染发生率及复发率等指标无差异.
To systematically assess whether it is safe and effective to preserve the left colonic artery during laparoscopic radical rectal resection in older adults
Objective:To evaluate the safety and efficacy of preserving the left colic artery during laparoscopic radical resection of rectal cancer in elderly patients.Methods:PubMed,EMBase,Cochrane Library,Web of Science,Wanfang,VIP,CNKI and other databases were searched from the establishment of the database to June 2023.Quality evaluation and data extraction were carried out for the included literatures,and meta-analysis was performed using statal6.0 software.Results:A total of 1 138 patients were included in 11 literatures,including 571 patients in the left colic artery preservation(LCA)group and 567 patients in the non-LCA group.Compared with the control group,the length of hospital stay in the LCA group(WMD=-0.844,95％CI=-1.064～-0.624,P＜0.05),the incidence of anastomostic fistula(RR=0.274,95％CI=0.149～0.504,P＜0.05),the number of lymph nodes dissection in IMA root(WMD=-0.264,95％CI=-0.365～-0.163,P＜0.05)were better than those in non-retention group.However,the duration of operation(WMD=9.518,95％CI=4.568～14.468,P＜0.05)and the rate of intraoperative bleeding were higher than those in the group without LCA(RR=3.239,95％CI=1.901～4.578,P＜0.05).For postoperative exhaust time(WMD=-0.364,95％CI=-0.669～-0.058,P＜0.05),incision infection rate(RR=1.022,95％CI=0.411～2.545,P=0.962),the number of total lymph node dissection(WMD=0.226,95％CI=-0.714～1.167,P=0.637),the incidence of intestinal obstruction(RR=0.708,95％CI=0.262～1.915,P=0.497)Recurrence rate(RR=1.183,95％CI=0.265～5.278,P=0.826),anastomotic bleeding rate(RR=0.979,95％CI=0.468～2.048),P=0.956),incidence of urinary retention(RR=0.633,95％CI=0.363～1.104,P=0.107).There was no significant difference.Conclusion:The length of hospital stay,the number of lymph node dissection at IMA root and the incidence of anastomotic fistula in left colic artery preservation group were better than those in non-preservation group.The operation time and bleeding rate were higher than those without LCA.There was no difference in postoperative exhaust time,incidence of incision infection and recurrence rate.
万方数据
维普
