中间入路与侧方入路腹腔镜结直肠切除术比较的Meta分析

目的：评价中间入路与侧方入路腹腔镜结直肠切除术治疗结直肠疾病的安全性与有效性。方法以Medline、Embase和Cochrane Library数据库作为已发表国外文献的主要来源，以万方数据知识服务平台和中国知网数据出版平台作为已发表国内文献的主要来源；检索时间：2013年4月20日。收集1994年1月1日至2013年4月20日公开发表的比较中间入路和侧方入路腹腔镜结直肠切除术的队列研究的中文和英文文献。结果筛选出符合纳入标准的队列研究5项，其中实施中间入路和侧方入路的患者分别为416例和465例。与侧方入路相比，中间入路腹腔镜手术的中转开腹率（OR＝0．42，95％CI：0．25～0．72，P＝0．001）、手术时间（WMD＝-51．56，95％CI：-72．72～-30．41，P＜0．01）均明显减少；出血量和住院费用仅有1篇文献报道未作合并分析；中间入路手术清扫的淋巴结数目也明显较少（WMD＝-1．17，95％CI：-1．89～-0．45，P＝0．001）。两种手术入路的术中并发症发生率（OR＝0．57，95％CI：0．15～2．18，P＝0．41）和术后并发症发生率（OR＝0．78，95％CI：0．52～1．17，P＝0．23）差异均无统计学意义。结论中间入路的腹腔镜结直肠切除术具有手术时间短、中转开腹率低的优势，而且其与侧方入路的手术安全性相当。但中间入路是否具有出血量少和住院费用低的优点，以及与侧方入路相似的肿瘤学安全性都有待于进一步研究。

Medial approach versus lateral approach in laparoscopic colorectal resection：a meta-analysis

Objective To compare the safety and efficacy of the medial approach （MA） and the lateral approach （LA） in the treatment of colorectal disease. Methods Studies published from January 1994 to April 2013 that compared MA to LA in laparoscopic colorectal resection were collected. Publications in English were mainly identified from Medline, Embase, Cochrane Library, and those in Chinese from Wanfang database and CNKI database. Conversion rate, operative time, blood loss, number of harvested lymph nodes, hospital stay, complication, mortality, recurrence, and hospitalization costs of MA and LA were meta-analyzed using fixed-effect and random-effect models. Results Five cohort studies （2 randomized controlled trials and 3 retrospective studies） including 881 patients were enrolled and analyzed. Of these patients, 416 and 465 underwent laparoscopic colorectal resection with MA and LA respectively. As compared to LA, MA had significantly lower conversion rate （OR=0.42, 95%CI：0.25-0.72,P=0.001）, shorter operative time（WMD=-52.62, 95%CI：-63.23--42.01, P〈0.01）, less number of harvested lymph nodes （WMD=-1.17, 95%CI：-1.89--0.45, P=0.001）, while blood loss was less and hospitalization cost lower. Significant differences in intraoperative complications and postoperative complications were not found between the two group （OR：0.57, 95%CI：0.15-2.18, P=0.41;OR：0.78,＆amp;nbsp;95%CI：0.52-1.17, P=0.23）. Conclusions Compared with LA, MA has the advantages of shorter operative time and lower conversion rate with similar safety. Differences in blood loss, hospitalization cost and oncological safety between the two approaches warrant further investigation.