中国循证医学杂志

中国循证医学杂志

3D 腹腔镜辅助结直肠癌手术疗效的 meta 分析

查看全文

目的 系统评价 3D 腹腔镜治疗结直肠癌的临床效果和安全性。 方法 计算机检索 PubMed、EMbase、The Cochrane Library、CBM、VIP、WanFang Data 和 CNKI 数据库,搜集有关 3D 腹腔镜辅助结直肠癌手术治疗的临床研究,检索时限均为建库至 2018 年 9 月 1 日。由 2 名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用 RevMan 5.3 软件进行 Meta 分析。 结果 共纳入 26 个临床研究,包括 4 个随机对照试验、5 个队列研究和 17 个病例-对照研究。Meta 分析结果显示:与 2D 腹腔镜相比,3D 腹腔镜辅助结直肠癌手术治疗的手术时间更短[MD=–16.32,95%CI(–22.61,–10.03),P<0.000 01]、术中出血量更少[MD=–10.80,95%CI(–19.93,–1.66),P=0.02]、清扫淋巴结数目更多[MD=0.88,95%CI(0.30,1.45),P=0.003]、胃肠道功能恢复时间更短[MD=–0.18,95%CI(–0.31,–0.04),P=0.01]、术后并发症发生率更低[OR=0.63,95%CI(0.44,0.89),P=0.009]、住院天数更短[MD=–0.84,95%CI(–1.40,–0.28),P=0.003],两组差异均有统计学意义。两组在住院费用[MD=–0.01,95%CI(–0.23,0.21),P=0.94]的差异无统计学意义。 结论 当前证据表明,与传统 2D 腹腔镜辅助结直肠癌手术相比,3D 腹腔镜辅助结直肠癌手术具有术中出血少、手术时间短、术后并发症发生率低、住院时间短、不增加住院费用等优势。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objective To systematically review the efficacy and safety of 3D laparoscopic in the treatment of colorectal cancer. Methods PubMed, EMbase, The Cochrane Library, CBM, VIP, WanFang Data and CNKI databases were electronically searched to collect clinical trials of 3D laparoscopic in the treatment of colorectal cancer from inception to September 1st, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then meta-analysis was performed by using RevMan 5.3 software. Results A total of 26 trials, including 4 randomized controlled trials, 5 cohort studies, and 17 case-control studies were included. The results of meta-analysis showed that: compared with 2D laparoscopic, 3D laparoscopic had shorter operative time (MD=–16.32, 95%CI –22.61 to –10.03, P<0.000 01), less amount of blood transfusion in operation (MD=–10.80, 95%CI –19.93 to –1.66,P=0.02), more lymph node dissection (MD=0.88, 95%CI 0.30 to 1.45, P=0.003), shorter recovery time of gastrointestinal function (MD=–0.18, 95%CI –0.31 to –0.04, P=0.01), lower incidence of postoperative complication (OR=0.63, 95%CI 0.44 to 0.89, P=0.009), fewer days in hospital (MD=–0.84, 95%CI –1.40 to –0.28, P=0.003), and there was no significant difference in hospitalization costs (MD=–0.01, 95%CI –0.23 to 0.21, P=0.94). Conclusion Current evidence shows that, compared with 2D laparoscopy, 3D laparoscopy assisted colorectal cancer surgery has obvious advantages such as less bleeding during operation, shorter operation time, lower incidence of complications after operation, shorter hospitalization time and no increase in hospitalization expenses. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.

关键词: 3D 腹腔镜; 2D 腹腔镜; 结直肠癌; Meta 分析; 系统评价

Key words: 3D laparoscopy; 2D laparoscopy; Colorectal neoplasm; Meta-analysis; Systematic review

登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Chen W, Zheng R, Baade PD, et al. Cancer statistics in china 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
2. Martel G, Crawford A, Barkun JS, et al. Expert opinion on laparoscopic surgery for colorectal cancer parallels evidence from a cumulative meta-analysis of randomized controlled trials. PLoS One, 2012, 7(4): e35292.
3. 张春燕, 孙莉. 3D 腹腔镜在胃癌手术中的应用效果及安全性的Meta分析. 中国普通外科杂志, 2016, 25(10): 1381-1387.
4. Currò G, La Malfa G, Caizzone A, et al. Three-dimensional (3D) versus two-dimensional (2D) laparoscopic bariatric surgery: a single-surgeon prospective randomized comparative study. Obes Surg, 2015, 25(11): 2120-2124.
5. Currò G, Cogliandolo A, Bartolotta M, et al. Three-dimensional versus two-dimensional laparoscopic right hemicolectomy. J Laparoendosc Adv Surg Tech A, 2016, 26(3): 213-217.
6. 汪天时, 刘铜军. 3D 腹腔镜手术的优势与应用前景. 中华结直肠疾病电子杂志, 2015, 4(5): 28-31.
7. 马君俊, 洪希周, 何子锐, 等. 3D 与 2D 腹腔镜结直肠癌根治术中术者主观感受的随机对照研究. 中华消化外科杂志, 2016, 15(9): 892-896.
8. Foo CC, Law WL. The learning curve of robotic-assisted low rectal resection of a novice rectal surgeon. World J Surg, 2016, 40(2): 456-462.
9. 池畔, 陈致奋. 腹腔镜不同途径与方法行全直肠系膜切除质量控制评价. 中国实用外科杂志, 2016, 36(1): 28-33.
10. 所剑, 张洋, 李伟. 3D 高清腹腔镜在低位直肠癌根治术中的应用. 中华消化外科杂志, 2016, 15(9): 878-881.
11. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ, 2009, 339: b2535.
12. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
13. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane Collaboration, 2011. Available at: www.handbook.cochrane.org.
14. Zeng Q, Lei F, Gao Z, et al. Case-matched study of short-term effects of 3D vs 2D laparoscopic radical resection of rectal cancer. World J Surg Oncol, 2017, 15(1): 178.
15. 洪希周, 马君俊, 董峰, 等. 3D 与 2D 腹腔镜系统在结直肠癌手术应用的随机对照研究. 腹部外科, 2017, 30(1): 23-26, 35.
16. 区颖豪, 粱丽婷, 陈晓, 等. 直肠癌进展期应用 3D 腹腔镜行根治性手术的临床观察. 中国医学创新, 2017, 14(14): 32-35.
17. 丁元升, 田相安, 孙钦立, 等. 3D 与 2D 腹腔镜下保留左结肠动脉的直肠癌根治术的临床对照研究. 饮食保健, 2018, 5(3): 22-23.
18. Tao K, Liu X, Deng M, et al. Three-dimensional against 2-dimensional laparoscopic colectomy for right-sided colon cancer. Surg Laparosc Endosc Percutan Tech, 2016, 26(4): 324-327.
19. 白军伟, 张超, 薛焕洲. 3D 与 2D 腹腔镜结直肠癌根治术的疗效分析. 中华消化外科杂志, 2016, 15(9): 897-901.
20. 费秉元, 姜俊男, 房学东, 等. 3D 与 2D 腹腔镜直肠癌根治术的疗效分析. 中华消化外科杂志, 2016, 15(8): 785-788.
21. 张庆彤, 刘亚莉, 张旭, 等. 3D 与 2D 腹腔镜手术治疗新辅助放化疗后直肠癌的疗效分析. 中华消化外科杂志, 2017, 16(8): 850-855.
22. 张庆彤, 刘亚莉, 张旭, 等. 可弯曲 3D 腹腔镜手术治疗新辅助放化疗后直肠癌临床效果分析. 肿瘤研究与临床, 2017, 29(2): 112-115, 128.
23. 陈海金, 俞金龙, 黄宗海, 等. 三维高清腹腔镜在腹腔镜直肠癌根治术中的应用. 中华解剖与临床杂志, 2014, 19(1): 49-50.
24. 季福建, 刘选文, 刘卓, 等. 3D 腹腔镜系统在进展期直肠癌闭孔淋巴结清扫中的应用. 中华胃肠外科杂志, 2014, 17(11): 1121-1124.
25. 宋京海, 贺修文, 陈剑, 等. 三维技术在腹部外科手术应用的初步经验. 中国医刊, 2015, 50(2): 62-64.
26. 于威, 刘铜军, 李春生, 等. 3D 与 2D 腹腔镜直肠癌根治术的对比研究. 中华普通外科杂志, 2015, 30(4): 297-299.
27. 宫子建, 马淑荣, 吉国锋, 等. 3D 腹腔镜在进展期直肠癌根治性手术中的应用. 中华普通外科杂志, 2016, 31(6): 506-507.
28. 戚少龙, 陶有茂, 吉国锋, 等. 3D 与 2D 腹腔镜右半结肠癌全结肠系膜切除术的临床疗效对比. 中华普通外科杂志, 2016, 31(9): 784-785.
29. 曾兵, 蔡灿锋, 辛海洋, 等. 3D 腹腔镜在右半结肠癌全结肠系膜切除术中的应用. 岭南现代临床外科, 2017, 17(1): 30-33.
30. 耿岩, 剧永乐, 陆光生, 等. 可旋转 3D 腹腔镜在直肠癌前切除术中的临床体会和特点. 岭南现代临床外科, 2017, 17(2): 162-165.
31. 郭欣, 吕小慧, 张珂诚, 等. 3D 与 2D 腹腔镜直肠癌根治术的疗效对比分析. 中华胃肠外科杂志, 2017, 20(10): 1190-1191.
32. 季福建, 房学东, 费秉元. 3D 与 2D 腹腔镜胃肠道肿瘤手术的比较研究. 中华胃肠外科杂志, 2017, 20(5): 509-513.
33. 李志澄, 彭翔, 计勇, 等. 比较 3D 腹腔镜和 2D 腹腔镜下直肠癌全直肠系膜切除术治疗直肠癌对患者术后并发症影响. 中国现代药物应用, 2017, (15): 42-43.
34. 屈鹏, 宋林杰, 那兴邦, 等. 3D 与传统 2D 腹腔镜辅助直肠癌 Dixon 术临床对比研究. 中华腔镜外科杂志(电子版), 2017, 10(5): 307-310.
35. 陶国全, 钱燕, 于仁, 等. 3D 腹腔镜在右半结肠癌根治术中的应用. 中国微创外科杂志, 2017, 17(7): 609-611, 626.
36. 王邓超, 余淼, 杨玉辉, 等. 三维腹腔镜在保留盆腔自主神经的直肠癌根治术中的应用. 中华腔镜外科杂志(电子版), 2017, 10(1): 46-49.
37. 肖旷, 郑勇斌, 童仕伦, 等. 3D 腹腔镜在直肠癌根治术中的临床应用探究. 临床急诊杂志, 2017, 18(12): 895-898.
38. 辛海洋, 曾兵, 蔡灿锋, 等. 3D 腹腔镜与 2D 腹腔镜在乙状结肠癌根治术中应用的近期疗效对比分析. 消化肿瘤杂志(电子版), 2017, 9(2): 99-102.
39. 龚铖, 刘权焰, 张进, 等. 腹腔镜结直肠癌手术疗效及安全性的系统评价. 中华外科杂志, 2011, 49(4): 346-350.
40. Serin KR, Gultekin FA, Batman B, et al. Robotic versus laparoscopic surgery for mid or low rectal cancer in male patients after neoadjuvant chemoradiation therapy: comparison of short-term outcomes. J Robot Surg, 2015, 9(3): 187-194.
41. Lusch A, Bucur PL, Menhadji AD, et al. Evaluation of the impact of three-dimensional vision on laparoscopic performance. J Endourol, 2014, 28(2): 261-266.
42. 蔡佳伟, 温晓峰, 林伟星, 等. 三维重建技术对肠系膜下动脉及左结肠动脉解剖变异的评估. 中华胃肠外科杂志, 2017, 20(11): 1274-1278.
43. Tanaka K, Shigemura K, Ishimura T, et al. Evaluation of a 3D system based on a high-quality flat screen and polarized glasses for use by surgical assistants during robotic surgery. Indian J Urol, 2014, 30(1): 13-16.
44. Spille J, Wenners A, von Hehn U, et al. 2D Versus 3D in laparoscopic surgery by beginners and experts: a randomized controlled trial on a pelvitrainer in objectively graded surgical steps. J Surg Educ, 2017, 74(5): 867-877.