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中华普通外科学文献(电子版) ›› 2020, Vol. 14 ›› Issue (02) : 154 -160. doi: 10.3877/cma.j.issn.1674-0793.2020.02.019

所属专题: 专题评论 文献

循证医学

全结肠系膜切除术治疗结肠癌的临床疗效与安全性评价
王少勇1, 张忠民1, 王光辉1,()   
  1. 1. 550002 贵阳,贵州省人民医院普外科
  • 收稿日期:2019-09-29 出版日期:2020-04-01
  • 通信作者: 王光辉
  • 基金资助:
    国家自然科学基金青年项目(81802479); 贵州省科学技术基金项目(黔科合J字〔2012〕2229号)

Clinical efficacy and safety of complete mesocolic excision in the treatment of colon cancer

Shaoyong Wang1, Zhongmin Zhang1, Guanghui Wang1,()   

  1. 1. Department of General Surgery, Guizhou Provincial People’s Hospital, Guiyang 550002, China
  • Received:2019-09-29 Published:2020-04-01
  • Corresponding author: Guanghui Wang
  • About author:
    Corresponding author: Wang Guanghui, Email:
引用本文:

王少勇, 张忠民, 王光辉. 全结肠系膜切除术治疗结肠癌的临床疗效与安全性评价[J/OL]. 中华普通外科学文献(电子版), 2020, 14(02): 154-160.

Shaoyong Wang, Zhongmin Zhang, Guanghui Wang. Clinical efficacy and safety of complete mesocolic excision in the treatment of colon cancer[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2020, 14(02): 154-160.

目的

系统评价结肠癌患者行全结肠系膜切除术(CME)的手术安全性、手术标本质量和远期预后效果。

方法

计算机检索PubMed、ScienceDirect、Cochrane、Scopus、中国知网和万方数据库中发表的相关文献,时间从建库至2018年12月。提取手术安全性、手术标本质量和远期生存率研究结果。

结果

共纳入15项研究8 914例患者。与传统非全结肠系膜切除术(NCME)组相比,CME组术后并发症明显增多(RR=1.23,95% CI:1.08~1.40),清扫的淋巴结数目更多(WMD=8.42,95% CI:4.71~12.13),肿瘤至血管高位结扎处的距离更长(WMD=18.43,95% CI:16.18~20.69),切除肠系膜的面积更大(WMD=35.07,95% CI:12.78~57.36),患者3年生存率(HR=0.72,95% CI:0.61~0.86)和5年生存率(HR=0.55,95% CI:0.42~0.73)更高(均P<0.01)。

结论

CME可以有效改善手术标本质量,延长术后远期生存率,但手术并发症的发生率较高,手术安全性问题应引起注意。

Objective

To evaluate the safety, sample quality and long-term prognosis of complete mesocolic excision (CME) for colorectal cancer.

Methods

The relevant documents published in PubMed, ScienceDirect, Cochrane, Scopus, CNKI and Wanfang databases were searched by computer from the establishment of the database to December 2018. The results of safety, quality and long-term survival were extracted.

Results

A total of 8 914 patients from 15 studies were included in this Meta-analysis. Compared with non-complete mesocolic excision (NCME) group, CME group had more complications (RR=1.23, 95% CI: 1.08-1.40), more lymph nodes (WMD=8.42, 95% CI: 4.71-12.13), longer distance from tumor to high ligation of blood vessels (WMD=18.43, 95% CI: 16.18-20.69), larger area of mesentery (WMD=35.07, 95% CI: 12.78-57.36). The 3-, 5- year survival rates of the patients in CME group were both higher (HR=0.72, 95% CI: 0.61-0.86; HR=0.55, 95% CI: 0.42-0.73; both P<0.01).

Conclusion

CME can effectively improve the quality of surgical specimens and prolong the long-term survival rate, but the incidence of surgical complications is high, so the safety of operation should be concerned.

表1 纳入研究信息汇总(CME/NCME)
图1 文献筛选流程图
表2 两种术式的手术安全性研究
图2 两种术式安全性比较的森林图 A为手术时间;B为术中出血量;C为手术并发症;D为术后病死率
表3 两种术式的手术标本质量研究
图3 两种术式质量研究结果比较的森林图 A为切除肠管长度;B为清扫淋巴结数目;C为肿瘤到血管高位结扎处的距离;D为切除肠系膜的面积
表4 两种术式的手术预后比较
图4 两种术式患者预后研究结果比较的森林图 A为3年生存率;B为5年生存率
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