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目的比较腹腔镜与开放手术行超低位直肠癌肛门括约肌间切除(ISR)的安全性和有效性。方法检索2014年12月前Pub Med、Medline、Ovid、CNKI和万方数据库中所有对比腹腔镜和开放手术行超低位直肠癌ISR的文献。将符合文献质量评价标准的文献纳入后,根据研究的异质性分别采用固定效应模型或随机效应模型进行荟萃分析。结果纳入10篇观察性研究共939例病人,腹腔镜手术和开放手术分别为501例和438例。与开放组相比,腹腔镜组手术时间(WMD=36.28,95%CI 4.30~68.26,P<0.05)延长,术中出血量(WMD=-95.84,95%CI-123.64~-68.03,P<0.01)减少,术后肛门排气时间(WMD=-1.05,95%CI-1.70~-0.41,P<0.01)、正常饮食时间(WMD=-0.95,95%CI-1.34~-0.55,P<0.01)和正常住院时间(WMD=-2.43,95%CI-3.95~-0.92,P<0.01)均缩短,总体术后并发症发生率(OR=0.60,95%CI 0.44~0.84,P<0.01)、环周切缘阳性率(OR=2.49,95%CI 1.12~5.54,P<0.05)和切口感染发生率(OR=0.20,95%CI 0.07~0.60,P<0.01)均降低;两组在局部复发率、远处转移率、吻合口漏及术后肠梗阻发生率方面差异均无统计学意义(均P>0.05)。结论腹腔镜手术行超低位直肠癌ISR短期及长期疗效满意,是一种微创、安全的保肛手术方法。
Objective To compare the safety and efficacy of laparoscopic and open surgery in the treatment of ultra-low rectal cancer anal sphincterotomy (ISR). METHODS: All articles from the Pub Med, Medline, Ovid, CNKI and Wanfang databases for the comparison of laparoscopic and open surgery for ultra-low rectal cancer ISR before December 2014 were searched. According to the heterogeneity of the study, the fixed-effect model or random-effect model was used to carry out the meta-analysis after the documents meeting the quality evaluation criteria were included. Results A total of 939 patients were enrolled in 10 observational studies. There were 501 and 438 cases of laparoscopic surgery and open surgery respectively. Compared with the open group, laparoscopic group had longer operative time (WMD = 36.28, 95% CI 4.30-68.26, P <0.05), and blood loss during operation (WMD = -95.84,95% CI -123.64 ~ -68.03, P < (WMD = -1.05,95% CI-1.70-0.41, P <0.01), and the time of normal eating (WMD = -0.95,95% CI-1.34-0.55, P < 0.01) and hospital stay (WMD = -2.43,95% CI-3.95-0.92, P <0.01), and the overall incidence of postoperative complications was significantly lower (OR = 0.60,95% CI 0.44-0.84, P <0.01) ), The positive rate of circumferential margin (OR = 2.49, 95% CI 1.12-5.54, P <0.05) and incision infection rate (OR = 0.20,95% CI 0.07-0.60, P <0.01) There was no significant difference in the local recurrence rate, distant metastasis rate, anastomotic leakage and the incidence of postoperative intestinal obstruction (all P> 0.05). Conclusions Laparoscopic surgery is a satisfactory and safe minimally invasive and safe method for the treatment of rectal cancer with short-term and long-term results.