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腹腔镜手术与开腹手术治疗结直肠癌的短期和长期结局:一项荟萃分析。

The short- and long-term outcomes of laparoscopic versus open surgery for colorectal cancer: a meta-analysis.

作者信息

Wang Chun-Li, Qu Gang, Xu Hong-Wei

机构信息

The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116021, People's Republic of China,

出版信息

Int J Colorectal Dis. 2014 Mar;29(3):309-20. doi: 10.1007/s00384-013-1827-1. Epub 2014 Jan 21.

Abstract

PURPOSE

The aim of the study was to compare short- and long-term outcomes of laparoscopic surgery and conventional open surgery for colorectal cancer.

METHODS

Published randomized controlled trial (RCT) reports of laparoscopic surgery and open surgery for colorectal cancer were searched, and short- and long-term factors were extracted to perform meta-analysis.

RESULTS

A total of 15 RCT reports (6,557 colorectal cancer patients) were included in this study. Blood loss of laparoscopic surgery was less by 91.06 ml than open surgery (p = 0.044). Operation time was longer by 49.34 min (p = 0.000). The length of hospital stay was shorter by 2.64 days (p = 0.003). Incisional length was shorter by 9.23 cm (p = 0.000). Fluid intake was shorter by 0.70 day (p = 0.001). Bowel movement was earlier by 0.95 day (p = 0.000). Incidence of complications, blood transfusion, and 30 days death were significantly lower in laparoscopic surgery than in open surgery (p = 0.011, 0.000, 0.01). But there was no significant difference in lymph nodes (p = 0.535) and anastomotic leak (p = 0.924). There was also no significant difference in 3 and 5 years overall survival (p = 0.298, 0.966), disease-free survival (p = 0.487, 0.356), local recurrence (p = 0.270, 0.649), and no difference in 5 years distant recurrence (p = 0.838).

CONCLUSIONS

Laparoscopic surgery is a mini-injured approach which can cure colorectal cancer safely and radically, and it is not different from conventional open surgery in long-term effectiveness, so laparoscopic surgery can be tried to widely use in colorectal cancer.

摘要

目的

本研究旨在比较腹腔镜手术与传统开放手术治疗结直肠癌的短期和长期疗效。

方法

检索已发表的关于腹腔镜手术和开放手术治疗结直肠癌的随机对照试验(RCT)报告,并提取短期和长期因素进行荟萃分析。

结果

本研究共纳入15篇RCT报告(6557例结直肠癌患者)。腹腔镜手术的失血量比开放手术少91.06 ml(p = 0.044)。手术时间长49.34分钟(p = 0.000)。住院时间短2.64天(p = 0.003)。切口长度短9.23 cm(p = 0.000)。液体摄入时间短0.70天(p = 0.001)。肠道蠕动恢复时间早0.95天(p = 0.000)。腹腔镜手术的并发症、输血发生率及30天死亡率均显著低于开放手术(p = 0.011、0.000、0.01)。但淋巴结(p = 0.535)和吻合口漏(p = 0.924)方面无显著差异。3年和5年总生存率(p = 0.298、0.966)、无病生存率(p = 0.487、0.356)、局部复发率(p = 0.270、0.649)也无显著差异,5年远处复发率无差异(p = 0.838)。

结论

腹腔镜手术是一种微创方法,能安全、根治性地治疗结直肠癌,且在长期疗效上与传统开放手术无异,因此可尝试在结直肠癌中广泛应用腹腔镜手术。

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