比较手助腹腔镜右半结肠切除术与开腹右半结肠切除术治疗右侧结肠癌的荟萃分析。
A meta-analysis comparing hand-assisted laparoscopic right hemicolectomy and open right hemicolectomy for right-sided colon cancer.
机构信息
Department B of Surgery, Charles Nicolle Hospital, University Tunis El Manar, Tunis, Tunisia.
Department of Colorectal Surgery, Queen Alexandra Hospital, Southwick Hill road, Cosham, Portsmouth, UK.
出版信息
World J Surg Oncol. 2020 May 7;18(1):91. doi: 10.1186/s12957-020-01869-w.
BACKGROUND
Mini-invasive colorectal cancer surgery was adopted widely in recent years. This meta-analysis aimed to compare hand-assisted laparoscopic surgery (HALS) with open right hemicolectomy (OS) for malignant disease.
METHODS
PRISMA guidelines with random effects model were adopted using Review Manager Version 5.3 for pooled estimates.
RESULTS
Seven studies that involved 506 patients were included. Compared to OS, HALS improved results in terms of blood loss (MD = 53.67, 95% CI 10.67 to 96.67, p = 0.01), time to first flatus (MD = 21.11, 95% CI 14.99 to 27.23, p < 0.00001), postoperative pain score, and overall hospital stay (MD = 3.47, 95% CI 2.12 to 4.82, p < 0.00001). There was no difference as concerns post-operative mortality, morbidity (OR = 1.55, 95% CI 0.89 to 2.7, p = 0.12), wound infection (OR = 1.69, 95% CI 0.60 to 4.76, p = 0.32), operative time (MD = - 16.10, 95% CI [- 36.57 to 4.36], p = 0.12), harvested lymph nodes (MD = 0.59, 95% CI - 0.18 to 1.36, p = 0.13), and recurrence (OR = 0.97, 95% CI 0.30 to 3.15, p = 0.96).
CONCLUSIONS
HALS is an efficient alternative to OS in right colectomy which combines the advantages of OS with the mini-invasive surgery.
背景
近年来，微创结直肠肿瘤手术得到广泛应用。本荟萃分析旨在比较手助腹腔镜手术（HALS）与开放式右半结肠切除术（OS）治疗恶性疾病的效果。
方法
采用 PRISMA 指南和随机效应模型，使用 Review Manager Version 5.3 进行汇总估计。
结果
纳入 7 项研究共 506 例患者。与 OS 相比，HALS 在出血量（MD = 53.67，95%CI 10.67 至 96.67，p = 0.01）、首次排气时间（MD = 21.11，95%CI 14.99 至 27.23，p < 0.00001）、术后疼痛评分和总住院时间（MD = 3.47，95%CI 2.12 至 4.82，p < 0.00001）方面有改善。在术后死亡率（OR = 1.55，95%CI 0.89 至 2.7，p = 0.12）、发病率（OR = 1.69，95%CI 0.60 至 4.76，p = 0.32）、切口感染（OR = 1.69，95%CI 0.60 至 4.76，p = 0.32）、手术时间（MD = -16.10，95%CI [-36.57 至 4.36]，p = 0.12）、清扫淋巴结数量（MD = 0.59，95%CI -0.18 至 1.36，p = 0.13）和复发率（OR = 0.97，95%CI 0.30 至 3.15，p = 0.96）方面无差异。
结论
HALS 是 OS 的有效替代方法，它结合了 OS 的优势和微创手术的优势。
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