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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/OL]. 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/OL]. 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
[1]
詹天成,李明,顾晋. 解读美国结直肠外科医师协会2013直肠癌治疗指南[J]. 中华胃肠外科杂志, 2013,16(8):701-709.
[2]
Lowry AC, Simmang CL, Boulos P, et al. Consensus statement of definitions for anorectal physiology and rectal cancer[J]. Colorectal Dis, 2001,3(4):272-275.
[3]
Komen N, Slieker J, de Kort P, et al. High tie versus low tie in rectal surgery: comparison of anastomotic perfusion[J]. Int J Colorectal Dis, 2011,26(8):1075-1078.
[4]
成军,周玲,陈涛, 等. 保留左结肠动脉的腹腔镜低位直肠癌前切除术[J]. 中国微创外科杂志, 2017,17(9):780-782.
[5]
伍颖君,李民. 保留左结肠动脉应用于腹腔镜低位直肠前切除术的临床研究[J]. 中华胃肠外科杂志, 2017,20(11):1313-1315.
[6]
牛晋卫,宁武,王文跃, 等. 保留左结肠动脉在腹腔镜下直肠癌前切除术中的临床作用[J]. 中华医学杂志, 2016,96(44):3582-3585.
[7]
张峪东,渠浩,杜燕夫, 等. 腹腔镜低位前切除手术中行肠系膜下动脉低位结扎及根部淋巴结廓清的可行性探讨[J]. 中华医学杂志, 2016,96(24):1916-1918.
[8]
张鲁阳,臧潞,马君俊, 等. 腹腔镜直肠癌根治术中保留左结肠动脉的临床意义[J]. 中华胃肠外科杂志, 2016,19(8):886-891.
[9]
袁志林,王博,杨雁灵, 等. 腹腔镜直肠癌前切除术中处理肠系膜下动脉时保留左结肠动脉的可行性评价[J]. 中国医师进修杂志, 2014,37(26):48-51.
[10]
尤小兰,王元杰,程之逸, 等. 腹腔镜直肠癌全直肠系膜切除术中保留左结肠动脉的临床研究[J]. 中华胃肠外科杂志, 2017,20(10):1162-1167.
[11]
骆洋,秦骏,陈建军, 等. 腹腔镜直肠癌手术中保留左结肠动脉与否疗效对比研究[J]. 中国实用外科杂志, 2017,37(6):660-664.
[12]
沈荐,李敏哲,杜燕夫, 等. 保留左结肠动脉的腹腔镜直肠癌低位前切除术的长期疗效分析[J]. 中华胃肠外科杂志, 2017,20(6):660-664.
[13]
沈荐,李敏哲,杜燕夫, 等. 腹腔镜直肠癌前切除术中保留左结肠动脉与否的临床对照研究[J]. 中国微创外科杂志, 2014,20(1):22-24,28.
[14]
郭世真. 腹腔镜下直肠癌根治术中保留左结肠动脉与否的临床对照研究[D]. 大连:大连医科大学外科学, 2016.
[15]
Guillou PJ, Quirke P, Thorpe H, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial[J]. Lancet, 2005,365(9472):1718-1726.
[16]
Cirocchi R, Trastulli S, Farinella E, et al. High tie versus low tie of the inferior mesenteric artery in colorectal cancer: a RCT is needed[J]. Surg Oncol, 2012,21(3):e111-e123.
[17]
Bruch HP, Schwandner O, Schiedeck TH, et al. Actual standards and controversies on operative technique and lymph-node dissection in colorectal cancer[J]. Langenbecks Arch Surg, 1999,384(2):167-175.
[18]
Hinoi T, Okajima M, Shimomura M, et al. Effect of left colonic artery preservation on anastomotic leakage in laparoscopic anterior resection for middle and low rectal cancer[J]. World J Surg, 2013,37(12):2935-2943.
[19]
中国抗癌协会大肠癌专业委员会腹腔镜外科学组,中华医学会外科分会腹腔镜与内镜外科学组. 腹腔镜结肠直肠癌根治手术操作指南(2006版)[J]. 外科理论与实践, 2006,11(5):462-464.
[20]
Seike K, Koda K, Saito N, et al. Laser Doppler assessment of the influence of division at the root of the inferior mesenteric artery on anastomotic blood flow in rectosigmoid cancer surgery[J]. Int J Colorectal Dis, 2007,22(6):689-697.
[21]
Jannasch O, Klinge T, Otto R, et al. Risk factors, short and long term outcome of anastomotic leaks in rectal cancer[J]. Oncotarget, 2015,6(34):36884-36893.
[22]
张广军,夏术森,刘作良, 等. 高位结扎肠系膜下动脉对直肠癌术后吻合口瘘的影响[J]. 中华普通外科杂志, 2013,28(2):90-92.
[23]
Bonnet S, Berger A, Hentati N, et al. High tie versus low tie vascular ligation of the inferior mesenteric artery in colorectal cancer surgery: impact on the gain in colon length and implications on the feasibility of anastomoses[J]. Dis Colon Rectum, 2012,55(5):515-521.
[24]
陈仕才,宋新明,陈志辉, 等. 肠系膜下动脉结扎方式对乙状结肠癌和直肠癌患者预后影响的Meta分析[J]. 中华胃肠外科杂志, 2010,13(9):674-677.
[25]
Liang JT, Lai HS. Surgical technique of robotic D3 lymph node dissection around the inferior mesenteric artery with preservation of the left colic artery and autonomic nerves for the treatment of distal rectal cancer[J]. Surg Endosc, 2014,28(5):1727-1733.
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