腹腔镜与开放横结肠切除术：系统评价与荟萃分析
Laparoscopic Versus Open Transverse Colectomy: A Systematic Review and Meta-Analysis.
作者信息
Gavriilidis Paschalis, Katsanos Konstantinos
机构信息
Department of General and Colorectal Surgery, Northern Lincolnshire and Goole, Diana, Princess of Wales Hospital, Scartho Road, Grimsby, DN33 2BA, UK.
Department of Interventional Radiology, School of Medicine, Patras University Hospital, 26504, Rion, Patras, Greece.
出版信息
World J Surg. 2018 Sep;42(9):3008-3014. doi: 10.1007/s00268-018-4570-5.
OBJECTIVES
The survival benefits, oncological adequacy, effectiveness, and safety of laparoscopic transverse colectomy (LTC) were compared with that of open transverse colectomy (OTC) using a meta-analysis.
METHODS
EMBASE, Medline, Cochrane library, and Google scholar databases were searched for the last 20 years. Meta-analyses were performed using both fixed-effects and random-effects models. Five-year disease-free survival and overall survival were estimated using the inverse variance hazard ratio method.
RESULTS
No survival benefits were detected between the two LTC and OTC cohorts. OTC showed shorter operative time by 38 min compared to LTC [mean difference (MD) = 38(15.23-60.77), p = 0.001]. However, LTC was associated with earlier postoperative recovery. The time to flatus and time to oral intake for LTC were MD = -1.12(-1.68 to -0.55, p = 0.001) and MD = -1.57(-2.38 to -0.76, p = 0.001), respectively. In addition, LTC was associated with a shorter hospital stay by 4.5 days [MD = -4.64(-7.52 to -1.75), p = 0.002].
CONCLUSIONS
Compared to OTC, LTC provides similar survival benefits, earlier postoperative recovery, and shorter hospital stay by 4.5 days.
目的
通过荟萃分析比较腹腔镜横结肠切除术（LTC）与开腹横结肠切除术（OTC）的生存获益、肿瘤学切除的充分性、有效性和安全性。
方法
检索过去20年的EMBASE、Medline、Cochrane图书馆和谷歌学术数据库。使用固定效应模型和随机效应模型进行荟萃分析。采用逆方差风险比方法估计5年无病生存率和总生存率。
结果
在LTC组和OTC组之间未检测到生存获益。与LTC相比，OTC的手术时间短38分钟[平均差（MD）=38（15.23 - 60.77），p = 0.001]。然而，LTC与术后恢复较早相关。LTC的排气时间和开始经口进食时间的平均差分别为MD = -1.12（-1.68至 -0.55，p = 0.001）和MD = -1.57（-2.38至 -0.76，p = 0.001）。此外，LTC与住院时间缩短4.5天相关[MD = -4.64（-7.52至 -1.75），p = 0.002]。
结论
与OTC相比，LTC具有相似的生存获益、术后恢复较早且住院时间缩短4.5天。
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