目的比较经自然腔道取标本手术(NOSES)与传统腹腔镜手术(CL)治疗结直肠癌的临床效果。方法通过检索PubMed、The Cochrane Library、EMbase、万方、知网数据库,收集NOSES术与CL术治疗结直肠癌的临床对照试验,检索时限为2010年1月至2018年10月。依照筛选标准,共有11篇文献入选,由两名作者分别独立地对入选研究中的有关试验设计、研究对象特征和研究结果等内容进行摘录,并用RevMan 5.3软件进行统计分析。结果共纳入11个研究,1 379例患者。Meta分析结果显示:与CL术相比,NOSES术后初次排气时间早(P < 0.01);术后疼痛轻(P < 0.01);总体并发症少(P < 0.01);术后切口感染发生少(P < 0.01)。两种术式在术中淋巴结清扫数量(P = 0.28)、术后吻合口漏发生率(P = 0.41)、术后3年生存率(P = 0.60)和术后5年生存率(P = 0.20)方面差异无统计学意义。结论NOSES术与CL术相比,术后无腹部辅助切口,且术后胃肠功能恢复较快、疼痛减轻、并发症较少,值得临床推广应用。
Objective To compare natural orifice specimen extraction surgery (NOSES) and conventional laparoscopy in treating colorectal cancer. Methods A search of clinical controlled trials published between January 2010 and October 2018 were per. formed on PubMed, The Cochrane Library, EMBASE, Wan Fang database, and CNKI. Eleven papers fulfilling the screening crite. ria were included. Data related to trial design, characteristics of study subjects and results were recorded independently by two authors. A meta-analysis was perform by RevMan 5.3. Results Eleven papers including 1379 patients were selected. Meta-analy. sis showed that compared with conventional laparoscopy, NOSES was associated with shorter time to first postoperative anal ex. haust (P < 0.01), fewer postoperative pain (P < 0.01), fewer overall complications (P <0.01), and fewer postoperative incision in. fection (P < 0.01). There was no significant difference between the two groups in lymph node yields (P = 0.28), incidence of postoperative anastomotic leak (P = 0.41), postoperative three-(P = 0.60) and five-year survival rates (P = 0.20). Conclusion Compared with conventional laparoscopy, NOSES does not involve auxiliary abdominal incision and is associated with faster recovery of postoperative gastrointestinal function, fewer pain, and fewer complications. It has a value in clinical practice.
Journal of Colorectal & Anal Surgery