目的

研究完整结肠系膜切除术(CME)对比传统结肠癌根治术的安全性与优越性。

方法

利用计算机检索国内外著名数据库近5 年内发表的关于CME 与传统结肠癌根治术对比研究的文献,遵循严格的筛选标准,提取高质量文献的数据资料,用Review Manager 5.3 软件进行系统评价,最后分析结果。

结果

共检索出初始文献约500 篇。 根据纳入与排除标准逐篇查阅、分析和评价,最终决定纳入10 项研究,其中5 篇为英文文献,5 篇为中文文献。 总病例1 447 例,其中CME 组733 例,传统手术组714 例。 (1)CME 组的术中出血量明显少于传统手术组[WMD=-28.17,95%CI=-52.77～-3.57,P=0.02],而两组的手术时间差异无统计学意义[WMD=3.70,95% CI= -18.25～25.66,P=0.74];(2)在术后病理标本淋巴结检出数、平均切除结肠长度和系膜面积以及营养血管长度等方面,CME 组均优于传统结肠癌手术组,P 分别小于0.01、0.01、0. 01 和0.05;(3)两组在术后首次排气时间以及住院时间方面差异均无统计学意义(P=0.45,0.08);(4)实行CME 并没有增加手术并发症发生率(P=0.89)。

结论

与传统结肠癌根治术相比,CME 更加符合外科解剖和胚胎学理念, 在未增加手术风险及术后并发症的前提下,达到了最大化的根治效果,安全、有效、可行,为结肠癌规范化的手术方式又增添了浓墨重彩的一笔。

Objective

To compare security and superiority between complete mesocolic excision(CME) and the traditional colon resection.

Methods

The literature comparing CME with traditional colon resection of the past five years were searched, following strict screening standard, to extract high quality literature data with Review Manager 5.3 software evaluating the final results.

Results

A total of ten nonrandomized clinical trials were selected out, five in English and five in Chinese. There were 1 447 cases in total, including 733 cases of CME group, and 714 cases of traditional surgery group. Meta-analysis results showed that: (1) CME group showed less blood loss than traditional surgery group [WMD=-28.17, 95% CI(-52.77, -3.57), P=0.02], but operative time difference was not statistically significant [WMD=3.70, 95% CI(-18.25, 25.66), P=0.74]. (2) As to the number of lymph node detected from postoperative pathological specimens, the average length of resected large bowel, the resected area of mesentery, and the high vascular ligation, CME group were superior to the traditional colon surgery group (P＜0.01, ＜0.01, ＜0.01 and ＜0.05).(3) There were no significant differences in the time of first flatus and the hospital stay between two groups(P=0.45, 0.08); (4) The implementation of CME did not increase the incidence of major complications (P=0.89).

Conclusions

CME is safe,effective, feasible and in conformity with the concept of surgery, anatomy and embryology. Compared with traditional colon resection, it has not increased the risk of surgery and postoperative complications.CME is likely to become a standardized operation method for colon cancer.