腹腔镜全直肠系膜切除术与经肛门全直肠系膜切除术治疗中低位直肠癌的疗效与安全性Meta分析
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1.贵州医科大学 临床医学院,贵州 贵阳 550025;2.贵州医科大学附属医院 肛肠外科,贵州 贵阳 550000

作者简介:

俞楠,贵州医科大学临床医学院硕士研究生,主要从事肛肠肿瘤方面的研究。

基金项目:

国家自然科学基金资助项目(82060440)。


Meta-analysis of efficacy and safety of laparoscopic total mesorectal excision and transanal total mesorectal resection in treatment of middle and low rectal cancer
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1.School of Clinical Medicine, Guizhou Medical University, Guiyang 550025, China;2.Department of Anorectal Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang 550000, China

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    摘要:

    背景与目的 尽管腹腔镜全直肠系膜切除术(LaTME)已广泛应用于直肠癌的治疗,但仍有其技术障碍,经肛门全直肠系膜切除术(TaTME)能够克服LaTME的缺点,在中低位直肠癌治疗中具有一定优势。然而,目前对TaTME的疗效与安全性仍有一些争议。因此,本研究通过Meta分析的方法比较TaTME与LaTME的近期疗效与安全性,为临床提供循证参考。方法 检索多个国内外数据库中有关TaTME与LaTME在中低位直肠癌治疗中比较研究。对纳入的文献提取资料及进行质量评价,采用Revman5.3软件行Meta分析。结果 共纳入18项对照研究,包含2 334例直肠癌的患者,其中TaTME组1 133例,LaTME组1 201例。Meta分析结果显示,TaTME组环周切缘(CRM)阳性率低于LaTME组(OR=0.58,95% CI=0.40~0.83,P=0.003),中转开放手术率低于LaTME组(OR=0.18,95% CI=0.11~0.31,P<0.000 01),术后住院时间短于LaTME组(WMD=-1.51,95% CI =-2.70~-0.33,P=0.01),R1切除率低于LaTME组(OR=0.30,95% CI=0.15~0.60,P=0.000 7)。两组收获的淋巴结数量、手术时间、术中出血量、直肠系膜切除完整度,CRM距离、远端切缘(DRM)阳性率、DRM距离、吻合口瘘发生率、肠梗阻发生率差异均无统计学意义(均P>0.05)。结论 在严格的手术适应证下,TaTME治疗中、低位直肠癌的安全性不亚于LaTME,且能达到更好的肿瘤学根治效果。但以上结论仍需要纳入更多的高质量研究加以验证。

    Abstract:

    Background and Aims Although the laparoscopic total mesorectal excision (LaTME) has been widely used in the treatment of rectal cancer, it still has technical obstacles. Transanal total mesorectal excision (TaTME) can overcome the limitations of LaTME and has certain advantages in the treatment of middle and low rectal cancer. However, there is still controversy over the efficacy and safety of TaTME. Therefore, this study was conducted to compare the short-term efficacy and safety of TaTME and LaTME through Meta, so as to provide evidence-based information for clinical decision-making.Methods The studies comparing TaTME and LaTME in the treatment middle and low rectal cancer were collected by searching several national and international online databases. After data extraction and quality evaluation of the included studies, Meta-analysis was performed using RevMan5.3 software.Results A total of 18 controlled studies were included, involving 2 334 patients with 1 133 cases in TaTME group and 1 201 cases in LaTME group. The results of Meta-analysis showed that the rate positive circumferential resection margin (CRM) (OR=0.58, 95% CI=0.40-0.83, P=0.003), open conversion rate (OR=0.18, 95% CI=0.11-0.31, P<0.000 01), length of hospital stay after surgery (WMD=-1.51, 95% CI =-2.70--0.33, P=0.01), and R1 resection rate (OR=0.30, 95% CI=0.15-0.60, P=0.000 7) were reduced in TaTME group compared with LaTME group; there were no significant differences in terms of the number of harvested lymph nodes, operative time, blood loss, completeness of mesorectal excision, CRM distance, rate of positive distal resection margin (DRM), DRM distance, and incidence rates of anastomotic leakage and intestinal obstruction (all P>0.05).Conclusion Under strict surgical indications, the safety of TaTME is not inferior to that of LaTME in the treatment of middle and low rectal cancer, and it also can achieve better oncological outcomes. However, the above conclusion still needs to be further verified by including more high-quality studies.

    表 1 纳入文献的基本特征Table 1 The general information of the included studies
    图1 文献检索流程图Fig.1 Literature screening process
    图2 RCT评价Fig.2 Evaluation of RCTs
    图3 两组手术时间比较Fig.3 Comparison of operative time between the two groups
    图4 两组术中出血量比较Fig.4 Comparison of intraoperative blood loss between the two groups
    图5 两组术中获取淋巴结数比较Fig.5 Comparison of number of harvested lymph nodes between the two groups
    图6 两组直肠系膜切除完整度比较Fig.6 Comparison of completeness of mesorectal excision between the two groups
    图7 两组CRM阳性率比较Fig.7 Comparison of positive CRM rates between the two groups
    图8 两组CRM距离比较Fig.8 Comparison of CRM distance between the two groups
    图9 两组DRM阳性率比较Fig.9 Comparison of positive DRM rates between the two groups
    图10 两组DRM距离比较Fig.10 Comparison of DRM distance between the two groups
    图11 两组R1切除率比较Fig.11 Comparison of R1 resection rates between the two groups
    图12 两组中转开放手术率比较Fig.12 Comparison of open conversion rates between the two groups
    图13 两组吻合口瘘发生率比较Fig.13 Comparison of incidence rates of anastomotic leakage between the two groups
    图14 两组肠梗阻发生率比较Fig.14 Comparison of incidence rates of intestinal obstruction between the two groups
    图15 两组术后住院时间比较Fig.15 Comparison of length of hospital stay between the two groups
    图16 肠梗阻发生率漏斗图Fig.16 Funnel plot of incidence of intestinal obstruction
    表 2 纳入文献的基本特征(续)Table 2 The general information of the included studies (continued)
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俞楠,甄运寰.腹腔镜全直肠系膜切除术与经肛门全直肠系膜切除术治疗中低位直肠癌的疗效与安全性Meta分析[J].中国普通外科杂志,2022,31(4):507-520.
DOI:10.7659/j. issn.1005-6947.2022.04.013

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  • 收稿日期:2021-09-06
  • 最后修改日期:2021-12-31
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  • 在线发布日期: 2022-05-07