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中华结直肠疾病电子杂志

中华结直肠疾病电子杂志 ›› 2020, Vol. 09 ›› Issue (01) : 61 -67. doi: 10.3877/cma.j.issn.2095-3224.2020.01.013

所属专题： 文献；

论著

3D与2D腹腔镜直肠癌根治术近期疗效的Meta分析
李来元1, 张维胜1, 冯丽莉1, 王涛1, 赵红军2, 段耀星1, 燕东1, 果茵茵3, 杨熊飞1,†()   
  1. 1. 730000　兰州，甘肃省人民医院肛肠科
    2. 730020　兰州，甘肃省疾病预防控制中心慢病所
    3. 730050　兰州大学第二医院药剂科
  • 收稿日期:2019-06-25 出版日期:2020-02-20
  • 通信作者: 杨熊飞
  • 基金资助:
    甘肃省科技计划项目(No.18JR3RA05)

The short-term efficacy of 3D versus 2D laparoscopic radical resection for rectal cancer: A meta analysis

Laiyuan Li1, Weisheng Zhang1, Lili Feng1, Tao Wang1, Hongjun Zhao2, Yaoxing Duan1, Dong Yan1, Yinyin Guo3, Xiongfei Yang1,†()   

  1. 1. Anorectal Department, Gansu Provincal Hospital, Lanzhou 730000, China
    2. Gansu Provincial Center for Disease Control and Prevention, Institute of Chronic Diseases, Lanzhou 730020, China
    3. Department of Pharmacy, Lanzhou University Second Hospital, Lanzhou 730050, China
  • Received:2019-06-25 Published:2020-02-20
  • Corresponding author: Xiongfei Yang
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李来元, 张维胜, 冯丽莉, 王涛, 赵红军, 段耀星, 燕东, 果茵茵, 杨熊飞. 3D与2D腹腔镜直肠癌根治术近期疗效的Meta分析[J]. 中华结直肠疾病电子杂志, 2020, 09(01): 61-67.

Laiyuan Li, Weisheng Zhang, Lili Feng, Tao Wang, Hongjun Zhao, Yaoxing Duan, Dong Yan, Yinyin Guo, Xiongfei Yang. The short-term efficacy of 3D versus 2D laparoscopic radical resection for rectal cancer: A meta analysis[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2020, 09(01): 61-67.

目的

系统评价3D与2D腹腔镜在直肠癌根治术的近期临床疗效。

方法

计算机检索PubMed、The Cochrane Library、Web of Science、Embase、CNKI、WanFang和VIP国内外数据库中比较3D与2D腹腔镜直肠癌根治术近期疗效的文献，并搜集相关文献的参考文献，检索时间从数据库建立至2019年3月1日。运用Review Manager 5.2软件对相关指标进行Meta分析。

结果

最终纳入11个研究，包含2个随机对照研究（RCT），9个非RCT，共1 169例患者纳入分析，其中3D腹腔镜组601例，2D腹腔镜组568例。3D腹腔镜组术中出血量（P<0.00001）、手术时间（P<0.00001）、首次排气时间（P<0.0001）、住院时间（P=0.04）、并发症发生率（P=0.04）、淋巴结获取数目（P<0.00001）均优于2D腹腔镜组，差异有统计学意义。两组中转开腹、环周切缘（CRM）阳性率比较，差异无统计学意义（P>0.05）。手术时间的漏斗图提示无发表偏倚（P=0.693）。

结论

与2D腹腔镜直肠癌手术相比，3D腹腔镜同样能够达到直肠癌根治性切除，且具有手术时间短、术中失血量少、术后并发症低、住院时间短、清扫淋巴结数目多等优势。

关键词: 直肠肿瘤, 腹腔镜, 3D, 2D, Meta分析
Objective

To systematically review the short-term clinical efficacy of 3D versus 2D laparoscopic radical resection for rectal cancer.

Methods

Such databases as PubMed, The Cochrane Library, Web of Science, EMbase, CNKI, WanFang and VIP were electronically searched for published articles at home and abroad on the short-term clinical efficacy of 3D versus 2D laparoscopic radical resection for rectal cancer from the database establishment to March 1st, 2019, and collected relevant literature references. Meta-analysis was performed using RevMan 5.2 software.

Results

A total of 1 169 patients were included in 11 studies (2 randomized controlled trials, RCTs, 9 nRCTs), including 601 patients in the 3D laparoscopic group and 568 patients in the 2D laparoscopic group. Blood loss (P<0.00001) , operation time (P<0.00001) , first flatu (P<0.0001) , hospital stay (P=0.04)), incidence of complications (P=0.04), harvested lymph node (P<0.00001) in the 3D laparoscopic group were all better than those in the 2D laparoscopic group, with statistically significant differences. However, no differences were observed in conversion rate and circumferential resection margin (CRM) positive rate (P>0.05). There was no evidence of publication bias in studies used for operation time (P=0.693).

Conclusion

Compared with 2D laparoscopic rectal cancer surgery, 3D laparoscopic surgery can also achieve radical resection of rectal cancer, and has the advantages of shorter operation time, less intraoperative blood loss, lower postoperative complications, shorter hospital stay, and more harvested lymph node.

Key words: Rectal neoplasms, Laparoscopes, 2D, 3D, Meta-analysis
图1 文献检索流程
表1 纳入文献的一般资料
作者，发表年份 研究类型 文献质量 3D vs. 2D
病例数 年龄（岁） 男性比例（%） 体质指数（kg/m2）
Curtis NJ，2019 RCT -/3 45 vs. 43 69±10 vs. 69±11 64 vs. 51 27±4 vs. 29±5
Zhang Q，2017 Pro 7★/- 76 vs. 76 55.3±2.3 vs.56.2±2.5 50 vs. 51 23.3±2.2 vs. 22.9±2.1
Zeng Q，2017 RCT -/3 23 vs. 23 NA 61 vs. 71 NA
Ji F，2017 Re 6★/- 27 vs. 18 66±12 vs. 69±7 70 vs. 61 NA
陈浩，2018 Re 6★/- 80 vs. 96 58.6±8.6 vs. 60.7±6.3 51 vs. 56 26.3±3.3 vs. 27.0±2.5
冯震，2018 Re 6★/- 86 vs. 62 63.8±9.4 vs. 66.8±8.9 54 vs. 60 24±3.2 vs. 23.4±2.6
郭欣，2017 Re 7★/- 71 vs. 66 59±7 vs. 61±9 65 vs. 68 23.9±2.1 vs. 24.2±1.9
屈鹏，2017 Re 6★/- 65 vs. 60 65.6±4.3 vs. 66.0 ±4.2 72 vs. 72 25.1±2.1 vs. 26.2±1.9
张庆彤，2017 Re 6★/- 63 vs. 63 55.5±2.4 vs. 56.5±3.8 32 vs. 30 23.6±1.5 vs. 23.1±1.4
费秉元，2016 Re 6★/- 47 vs. 50 56±8 vs. 58±7 66 vs. 78 NA
曾庆敏，2016 Re 7★/- 18 vs. 17 NA 56 vs. 53 NA
图2 3D与2D腹腔镜直肠癌根治术术后并发症发生率的比较
图3 3D与2D腹腔镜直肠癌根治术中转开腹的比较
图4 3D与2D腹腔镜直肠癌根治术淋巴结获取数目（4A）和CRM阳性率（4B）的比较
表2 3D与2D腹腔镜直肠癌根治术手术时间、术中出血量、首次排气时间、住院时间的比较
次要指标 纳入文献（篇） 3D组病例数 2D组病例数 WMD,（95%，CI） P值 异质性
χ2值 df I2，% P值
手术时间（min） 11 601 574 -18.00［-23.49，-12.51］ <0.00001 69.00 10 86 <0.00001
术中出血量（mL） 10 556 531 -18.74［-27.37，-10.11］ <0.0001 68.58 9 87 <0.00001
首次排气时间（天） 5 266 241 -0.10［-0.15，-0.05］ <0.0001 7.87 4 49 0.10
住院时间（天） 8 443 451 -1.10［-2.13，-0.07］ 0.04 127.79 7 95 <0.00001
图5 检验手术时间研究发生偏倚的漏斗图
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