本文選題：結直腸癌　切入點：腹腔鏡　出處：《中南大學學報(醫(yī)學版)》2017年01期 　論文類型：期刊論文

【摘要】：目的:評價腹腔鏡下腹部無切口結直腸癌切除術較之傳統腹腔鏡下結直腸癌切除術的可行性和安全性。方法:檢索2005年8月至2015年8月公開發(fā)表的腹腔鏡下腹部無切口結直腸癌切除對比傳統腹腔鏡下結直腸癌切除術應用情況的文獻。按納入標準篩選后進行質量評分,提取臨床效應指標,采用Review Maneger 5.3軟件對所納入的數據進行Meta分析。結果:最終納入7項研究,共621例患者,其中無輔助切口組(NOSE組)262例,傳統腹腔鏡組(LAP組)359例。Meta分析結果顯示總并發(fā)癥發(fā)生率的對比NOSE組明顯較LAP組少(OR=0.31,95%CI:0.18~0.53,P0.05)。對并發(fā)癥進行亞組分析,其中切口并發(fā)癥NOSE組較LAP組少(OR=0.15,95%CI:0.05~0.40,P=0.0002);術后出血(OR=1.52,95%CI:0.38~6.18,P=0.55)、腸梗阻(OR=0.30,95%CI:0.09~0.98,P=0.05)、吻合口相關并發(fā)癥(OR=0.92,95%CI:0.28~3.07,P=0.89)、其他相關并發(fā)癥(OR=0.63,95%CI:0.23~1.66,P=0.35)等亞組兩組比較差異無統計學意義;住院時間(MD= 0.66,95%CI: 1.33~0.01,P=0.05)、手術持續(xù)時間(MD=14.78,95%CI: 1.75~31.31,P=0.08)、術中出血量(MD= 12.81,95%CI: 40.36~14.74,P=0.36)、切除腫瘤大小(SMD= 0.40,95%CI: 0.87~0.08,P=0.10)、淋巴結清掃(MD= 0.49,95%CI:1.80~0.82,P=0.46)、隨診2年腫瘤復發(fā)(OR=1.15,95%CI:0.38~3.50,P=0.81)等指標NOSE組與LAP組比較差異均無統計學意義;術后肛門首次排氣時間(SMD= 0.62,95%CI: 0.82~ 0.42,P0.001)及術后恢復進食時間(SMD= 0.60,95%CI: 1.15~ 0.05,P=0.03)NOSE組均較LAP組更早;術后疼痛指數(MD= 1.49,95%CI: 1.97~ 1.01,P0.001)NOSE組較LAP組明顯較低;且NOSE組具有更好的美容效果(MD=1.37,95%CI:0.59~2.14,P=0.0005)。結論:腹腔鏡輔助腹部無輔助切口結直腸癌切除可顯著減少患者切口并發(fā)癥的發(fā)生,并可減輕患者疼痛,加快術后恢復,具有更好的美容效果,是治療結直腸癌安全、可行、有效的方法。
[Abstract]:Objective: to evaluate the feasibility and safety of laparoscopic laparoscopic resection of colorectal cancer without incision compared with traditional laparoscopic resection of colorectal cancer. Literature on the application of non-incisional resection of colorectal cancer to conventional laparoscopic resection of colorectal cancer. The clinical effect indexes were extracted and analyzed by Meta with Review Maneger 5.3 software. Results: a total of 621 patients were included in 7 studies, including 262 cases in the no assistant incision group. The results of Meta-analysis showed that the incidence of total complications in the NOSE group was significantly lower than that in the LAP group, and the incidence of complications in the NOSE group was significantly lower than that in the LAP group. The complications of incision in the NOSE group were less than those in the LAP group. The complications of incision in NOSE group were less than those in LAP group. There was no significant difference between the two groups, such as the group of postoperative bleeding: 1.5295 CI: 0.382.95CI0.386.18P0.55, the group of intestinal obstruction: 0.090.98P0.05, the complication of anastomosis: 0.28295 CIW 0.283.03.0P0.89.The other related complications were 0.6395CI0.231.66P0.35. there was no significant difference between the two groups. The duration of hospitalization was 1.330.01P0.05C, and the duration of operation was 1.7531.31P0.08. The amount of intraoperative bleeding was 40.3614.74P0.360.3614.74P0.36CI.There was no significant difference between the NOSE group and the LAP group, and there was no significant difference between the NOSE group and the LAP group. The time of the first exsufflation of anus after operation (SD = 0.62 ~ 0.42% P0.001) and the time of recovery of food after operation were 1.15 ~ 0.05 ~ 0.05 and 0.03% respectively earlier than those in the LAP group, and the postoperative pain index (MD = 1.4995 CI: 1.971P 0.001) was significantly lower than that in the LAP group. The postoperative pain index of the two groups was significantly lower than that of the LAP group, and the postoperative pain index of the two groups was significantly lower than that of the LAP group (P < 0.05). The postoperative pain index of the two groups was significantly lower than that of the LAP group. The postoperative pain index of the two groups was significantly lower than that of the LAP group. And NOSE group has better cosmetic effect. Conclusion: laparoscopic assisted abdominal resection of colorectal cancer can significantly reduce the incidence of incision complications, alleviate pain and accelerate postoperative recovery, and has a better cosmetic effect. It is a safe, feasible and effective method for the treatment of colorectal cancer.
【作者單位】： 新鋼中心醫(yī)院普外1科;南昌大學第二附屬醫(yī)院胃腸外科;
【分類號】：R735.34

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本文編號：1604431