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中华普通外科学文献(电子版) ›› 2018, Vol. 12 ›› Issue (05) : 367 -372. doi: 10.3877/cma.j.issn.1674-0793.2018.05.020

所属专题: 文献

循证医学

腹腔镜直肠癌前切除术中保留左结肠动脉与否的Meta分析
任龙1, 张云1, 沈正海1,()   
  1. 1. 214200 无锡,江苏大学附属宜兴医院普外科
  • 收稿日期:2018-05-03 出版日期:2018-10-01
  • 通信作者: 沈正海

Preservation of left colon artery or not in laparoscopic anterior resection of rectal cancer: A Meta-analysis

Long Ren1, Yun Zhang1, Zhenghai Shen1,()   

  1. 1. Department of General Surgery, Yixing Hospital Affiliated to Jiangsu University, Wuxi 214200, China
  • Received:2018-05-03 Published:2018-10-01
  • Corresponding author: Zhenghai Shen
  • About author:
    Corresponding author: Shen Zhenghai, Email:
引用本文:

任龙, 张云, 沈正海. 腹腔镜直肠癌前切除术中保留左结肠动脉与否的Meta分析[J]. 中华普通外科学文献(电子版), 2018, 12(05): 367-372.

Long Ren, Yun Zhang, Zhenghai Shen. Preservation of left colon artery or not in laparoscopic anterior resection of rectal cancer: A Meta-analysis[J]. Chinese Archives of General Surgery(Electronic Edition), 2018, 12(05): 367-372.

目的

系统评价腹腔镜直肠癌前切除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、Sinomed、万方、维普、中国知网等数据库,文献检索起止时间均从建库至2018年2月。对纳入文献进行质量评价和数据提取,应用Revman 5.3软件进行Meta分析。

结果

共纳入12篇文献1 863例患者,其中高位结扎(HT)组937例,低位结扎(LT)组926例。与HT组相比,LT组吻合口瘘发生率(OR=2.77,95%CI=1.73~4.42,P<0.001)、游离脾曲(OR=13.00,95%CI=3.90~43.37,P<0.001)及预防性回肠造口(OR=2.29,95%CI=1.55~3.38,P<0.001)均下降;两组肠系膜下动脉根部淋巴结清扫数(WMD=0.03,95%CI= -0.14~0.21,P=0.69)、总淋巴结清扫数(WMD=0.40,95%CI= 0~0.80,P=0.05)及复发转移率(OR=0.96,95%CI= 0.68~1.35,P=0.79)差异无统计学意义。HT组手术时间短于LT组(WMD=-7.06,95%CI= -10.75~-3.36,P<0.001)。

结论

腹腔镜直肠癌前切除术中低位结扎肠系膜下动脉,在吻合口瘘等近期疗效指标有获益,但在复发转移无获益。

Objective

To systematically review the safety and effectiveness of preserving the left colic artery (LCA) in laparoscopic anterior resection of rectal cancer.

Methods

A literature search was conducted on the databases which included the PubMed, EMBase, Cochrane library, Sinomed, Wanfang, VIP, and CNKI. The retrieval time was from inception to February 2018. Meta analysis was performed using Revman 5.3 software.

Results

A total of 1 863 patients were included in 12 articles. Among them, 937 cases were high tie group (preservation of LCA), and 926 cases in the low tie group (without preservation of LCA). Compared with group HT, the anastomotic leakage (OR=2.77; 95%CI: 1.73, 4.42; P<0.001), free splenic flexure (OR=13.00; 95%CI: 3.90, 43.37; P<0.001) and prophylactic ileostomy (OR=2.29; 95%CI: 1.55, 3.38; P<0.001) in group LT were all decreased. There were no significant differences in the number of lymph nodes removed around the root of inferior mesenteric artery (WMD=0.03; 95%CI: -0.14, -0.21; P=0.69) , the total of lymph nodes dissection (WMD=0.40; 95%CI: 0, 0.80; P=0.05) and the rate of the recurrence and metastasis (OR=0.96; 95%CI: 0.68, 1.35; P=0.79). The operation time of group HT was shorter than that of group LT (WMD=-7.06; 95%CI: -10.75, -3.36; P<0.001).

Conclusion

Low ligation of inferior mesenteric artery and preservation of LCA has benefit in recent therapeutic effects such as anastomotic leakage, but there was no benefit in relapse or metastasis.

表1 12篇文献纳入患者的基线资料
图1 HT组与LT组腹腔镜直肠癌前切除术后吻合口瘘对比
图2 HT组与LT组腹腔镜直肠癌前切除术游离脾曲对比
图3 HT组与LT组腹腔镜直肠癌前切除术预防性回肠造口对比
图4 HT组与LT组腹腔镜直肠癌前切除术肠系膜下动脉根部淋巴结清扫数对比
图5 HT组与LT组腹腔镜直肠癌前切除术淋巴结清扫总数比较
图6 HT组与LT组腹腔镜直肠癌前切除术手术时间对比
图7 HT组与LT组腹腔镜直肠癌前切除术后复发转移对比
图8 以术后吻合口瘘为评价指标的漏斗图
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