低位直肠癌侧方淋巴结清扫术的Meta分析

摘要

目的:探讨低位直肠癌侧方淋巴结清扫的意义.方法:计算机检索The Cochrane library、Pubmed、EMbase、CBM、维普数据库、中国知网、万方数据库,检索时间为2000年1月-2015年10月,纳入低位直肠癌侧方淋巴结清扫术的对比研究,用revman5.2处理数据,评价低位直肠癌侧方淋巴结清扫术的意义.结果:纳入公开发表的9篇临床对比研究,以低位直肠癌行侧方淋巴结清扫术患者为观察组,传统手术患者为对照组进行Meta分析.观察组手术时间长于对照组,差异有统计学意义[MD=-42.48,95％CI(32.92,-52.04),P＜0.00001];观察组术中出血量大于对照组,差异有统计学意义[MD=-18.72,95％CI(5.60,31.83),P＜0.005];观察组局部复发率低于对照组,差异有统计学意义[OR=-0.52,95％CI(0.38,0.71),P＜0.0001];观察组3年生存率、5年生存率均高于对照组,差异有统计学意义,其合并OR和95％CI分别为OR=2.65,95％CI(1.76,3.99)(P＜0.00001)和OR=3.57,95％CI(2.05,6.22)(P＜0.00001).结论:低位直肠癌行侧方淋巴结清扫术增加患者手术时间、出血量及术后并发症发生风险,但提高患者生存率.%Objective:To explore the significance of lateral lymph node dissection for low rectal cancer.Methods:Retrieval the Cochrane Library,PubMed,EMBASE,CBM,VIP,CNKI,WANFANG DATA,the time is from January 2000 to October 2015.Bring into the comparative studies about lateral lymph node dissection for low rectal cancer.Processing data using the revman 5.2 to reaserch the significance of lateral lymph node dissection for low rectal cancer.Results:9 clinical comparative studies were included in this study.The observation group was the lateral lymph node dissection group and the control group was the traditional operation group.Results showed that the length of incision of the observation group was longer [MD=-42.48,95％CI (32.92,-52.04),P＜0.00001],The amount of bleeding in observation group was more[MD=-18.72,95％Cl(5.60,31.83),P＜0.005],The local recurrence rate in the observation group was Iower[OR=-0.52,95％CI (0.38,0.71),P＜0.0001],The 3 year survival rate and the 5 year survival rate in the observation group were higher than those in the control group,the difference was statistically significant,Their combined OR and 95％CI were [OR=2.65,95％ CI (1.76,3.99),P＜0.00001] and [OR=3.57,95％ CI (2.05,6.22),P＜0.00001].Conclusion:Lateral lymph node dissection increasing operation time、hemorrhage volume and postoperative complication risk,but could increase the survival rate of the patients.