经自然腔道取标本手术与传统腹腔镜手术治疗结直肠癌临床效果的Meta分析
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摘要
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 performed on PubMed, The Cochrane Library, EMBASE, Wan Fang database, and CNKI. Eleven papers fulfilling the screening criteria 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-analysis showed that compared with conventional laparoscopy, NOSES was associated with shorter time to first postoperative anal exhaust(P < 0.01), fewer postoperative pain(P < 0.01), fewer overall complications(P <0.01), and fewer postoperative incision infection(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.
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 performed on PubMed, The Cochrane Library, EMBASE, Wan Fang database, and CNKI. Eleven papers fulfilling the screening criteria 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-analysis showed that compared with conventional laparoscopy, NOSES was associated with shorter time to first postoperative anal exhaust(P < 0.01), fewer postoperative pain(P < 0.01), fewer overall complications(P <0.01), and fewer postoperative incision infection(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.
引文
[1]郑树,张苏展,黄彦钦.结直肠癌研究30年回顾和现状[J].实用肿瘤杂志,2016,31(1):2-5.
[2]汤庆超,陈瑛罡,王锡山.腹部无切口经阴道拉出切除标本的腹腔镜中位直肠癌根治术[J].中华胃肠外科杂志,2014,17(12):1233-1235.
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[6]A STANG:Critical evaluation of the Newcastle-Ottawa scale for the assessment ofthe quality ofnonrandomized studies in meta-analyses[J].Eur J Epidemiol,2010,25(9):603-605.
[7]HIGGINS.Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0.the cochrane collaboration 2011;available from www.cochrane-handbook.org.
[8]AWAD Z T,GRIFFIN R.Laparoscopic right hemicolectomy:a comparison of natural orifice versus transabdominal specimen extraction[J].Surg Endosc,2014,28(10):2871-2876.
[9]DENOST Q,ADAM J P,PONTALLIER A,et al.Laparoscopic total mesorectal excision with coloanal anastomosis for rectal cancer[J].Ann Surg,2015,261(1):138-143.
[10]HISADA M,KATSUMATA K,ISHIZAKI T,et al.Complete laparoscopic resection of the rectum using natural orifice specimen extraction[J].World J Gastroenterol,2014,20(44):16707-16713.
[11]KIM H J,CHOI G S,PARK J S,et al.Transvaginal specimen extraction versus conventional minilaparotomy after laparoscopic anterior resection for colorectal cancer:mid-term results of a case-matched study[J].Surg Endosc,2014,28(8):2342-2348.
[12]LEUNG A L H,CHEUNG H Y S,FOK B K L,et al.Prospective randomized trial of hybrid NOTES colectomy versus conventional laparoscopic colectomy for left-sided colonic tumors[J].World J Surg,2013,37(11):2678-2682.
[13]NG H I,SUN W Q,ZHAO X M,et al.Outcomes of transanal natural orifice specimen extraction combined with laparoscopic anterior resection for sigmoid and rectal carcinoma:An observational study[J].Medicine,2018,97(38):e12347.
[14]PARK J S,KANG H,PARK S Y.Long-term outcomes after natural orifice specimen extraction versus conventional laparoscopy-assisted surgery for rectal cancer a matched case-control study[J].Ann Surg Treat Res,2018,94(1):26-35.
[15]SAURABH B,CHANG S C,KE T W,et al.Natural orifice specimen extraction with single stapling colorectal anastomosis for laparoscopic anterior resection:feasibility,outcomes,and technical considerations[J].Dis Colon Rectum,2017,60(1):43-50.
[16]WOLTHUIS A M,FIEUWS S,VAN D B A,et al.Randomized clinical trial of laparoscopic colectomy with or without naturalorifice specimen extraction[J].Br J Surg,2015,102(6):630-637.
[17]ZHANG X M,ZHOU H T,LIANG J W,et al.Totally laparoscopic resection with natural orifice specimen extraction(NOSE)has more advantages comparing with laparoscopic-assisted resection for selected patients with sigmoid colon or rectal cancer[J].Int J Colorectal Dis,2014,29(9):1119-1124.
[18]胡俊杰,魏少忠,熊治国,等.结直肠癌NOSES术的近期效果及对机体细胞免疫功能影响的研究[J].中华结直肠疾病电子杂志,2016,5(4):323-327.
[19]谢方利,韩伟,陈志刚,等.腹腔镜结直肠癌手术与传统根治术临床对比研究[J].结直肠肛门外科,2010,16(4):223-226.
[20]BUCHER P,PUGIN F,MOREL P,et al.[Scarless surgery:myth or reality through NOTES?][J].Rev Med Suisse,2008,4(163):1550-1552.
[21]王成锋,赵平.应重视恶性肿瘤手术中的淋巴结清扫[J].中华医学杂志,2005,85(22):1516-1518.
[22]吴红杰,邹小明.结直肠癌术后吻合口瘘的诊治及预防[J].中华结直肠疾病电子杂志,2016,5(2):171-174.
[23]KANTSEVOY S V.Infection Prevention in NOTES[J].Gastrointest Endosc Clin N Am,2008,18(2):291-296
[24]NGU J,WONG A S.Transanal natural orifice specimen extraction in colorectal surgery:bacteriological and oncological concerns[J].ANZ J Surg,2016,86(4):299-302.
[25]AWAD Z T,GRIFFIN R.Laparoscopic right hemicolectomy:a comparison of natural orifice versus transabdominal specimen extraction[J].Surg Endosc,2014,28(10):2871-2876.
[26]LEUNG A L H,CHEUNG H Y S,LI M K W.Advances in laparoscopic colorectal surgery:A review on NOTES and transanal extraction of specimen[J].Asian J Endosc Surg,2014,7(1):11-16.
[27]彭健,丁成明,贾泽民,等.NOSES结直肠癌根治术后腹腔冲洗液肿瘤细胞学检测及细菌培养结果分析[J/CD].中华结直肠疾病电子杂志,2018,7(4):342-346.
[28]COSTANTINO F A,DIANA M,WALL J,et al.Prospective evaluation of peritoneal fluid contamination following transabdominal vs.transanal specimen extraction in laparoscopic left-sided colorectal resections[J].Surg Endosc,2012,26(6):1495-1500.
[2]汤庆超,陈瑛罡,王锡山.腹部无切口经阴道拉出切除标本的腹腔镜中位直肠癌根治术[J].中华胃肠外科杂志,2014,17(12):1233-1235.
[3]PALANIVELU C,RANGARAJAN M,JATEGAONKAR P A,et al.An innovative technique for colorectal specimen retrieval:a new era of"natural orifice specimen extraction"(N.O.S.E)[J].Dis Colon Rectum,2008,51(7):1120-1124.
[4]王锡山.结直肠肿瘤类-NOTES术之现状及展望[J].中华结直肠疾病电子杂志,2015,4(4):11-16.
[5]FONG D G,PAI R D,THOMPSON C C.Transcolonic endoscopic abdominal exploration:a NOTES survival study in a porcine model[J].Gastrointest Endosc,2007,65(2):312-318.
[6]A STANG:Critical evaluation of the Newcastle-Ottawa scale for the assessment ofthe quality ofnonrandomized studies in meta-analyses[J].Eur J Epidemiol,2010,25(9):603-605.
[7]HIGGINS.Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0.the cochrane collaboration 2011;available from www.cochrane-handbook.org.
[8]AWAD Z T,GRIFFIN R.Laparoscopic right hemicolectomy:a comparison of natural orifice versus transabdominal specimen extraction[J].Surg Endosc,2014,28(10):2871-2876.
[9]DENOST Q,ADAM J P,PONTALLIER A,et al.Laparoscopic total mesorectal excision with coloanal anastomosis for rectal cancer[J].Ann Surg,2015,261(1):138-143.
[10]HISADA M,KATSUMATA K,ISHIZAKI T,et al.Complete laparoscopic resection of the rectum using natural orifice specimen extraction[J].World J Gastroenterol,2014,20(44):16707-16713.
[11]KIM H J,CHOI G S,PARK J S,et al.Transvaginal specimen extraction versus conventional minilaparotomy after laparoscopic anterior resection for colorectal cancer:mid-term results of a case-matched study[J].Surg Endosc,2014,28(8):2342-2348.
[12]LEUNG A L H,CHEUNG H Y S,FOK B K L,et al.Prospective randomized trial of hybrid NOTES colectomy versus conventional laparoscopic colectomy for left-sided colonic tumors[J].World J Surg,2013,37(11):2678-2682.
[13]NG H I,SUN W Q,ZHAO X M,et al.Outcomes of transanal natural orifice specimen extraction combined with laparoscopic anterior resection for sigmoid and rectal carcinoma:An observational study[J].Medicine,2018,97(38):e12347.
[14]PARK J S,KANG H,PARK S Y.Long-term outcomes after natural orifice specimen extraction versus conventional laparoscopy-assisted surgery for rectal cancer a matched case-control study[J].Ann Surg Treat Res,2018,94(1):26-35.
[15]SAURABH B,CHANG S C,KE T W,et al.Natural orifice specimen extraction with single stapling colorectal anastomosis for laparoscopic anterior resection:feasibility,outcomes,and technical considerations[J].Dis Colon Rectum,2017,60(1):43-50.
[16]WOLTHUIS A M,FIEUWS S,VAN D B A,et al.Randomized clinical trial of laparoscopic colectomy with or without naturalorifice specimen extraction[J].Br J Surg,2015,102(6):630-637.
[17]ZHANG X M,ZHOU H T,LIANG J W,et al.Totally laparoscopic resection with natural orifice specimen extraction(NOSE)has more advantages comparing with laparoscopic-assisted resection for selected patients with sigmoid colon or rectal cancer[J].Int J Colorectal Dis,2014,29(9):1119-1124.
[18]胡俊杰,魏少忠,熊治国,等.结直肠癌NOSES术的近期效果及对机体细胞免疫功能影响的研究[J].中华结直肠疾病电子杂志,2016,5(4):323-327.
[19]谢方利,韩伟,陈志刚,等.腹腔镜结直肠癌手术与传统根治术临床对比研究[J].结直肠肛门外科,2010,16(4):223-226.
[20]BUCHER P,PUGIN F,MOREL P,et al.[Scarless surgery:myth or reality through NOTES?][J].Rev Med Suisse,2008,4(163):1550-1552.
[21]王成锋,赵平.应重视恶性肿瘤手术中的淋巴结清扫[J].中华医学杂志,2005,85(22):1516-1518.
[22]吴红杰,邹小明.结直肠癌术后吻合口瘘的诊治及预防[J].中华结直肠疾病电子杂志,2016,5(2):171-174.
[23]KANTSEVOY S V.Infection Prevention in NOTES[J].Gastrointest Endosc Clin N Am,2008,18(2):291-296
[24]NGU J,WONG A S.Transanal natural orifice specimen extraction in colorectal surgery:bacteriological and oncological concerns[J].ANZ J Surg,2016,86(4):299-302.
[25]AWAD Z T,GRIFFIN R.Laparoscopic right hemicolectomy:a comparison of natural orifice versus transabdominal specimen extraction[J].Surg Endosc,2014,28(10):2871-2876.
[26]LEUNG A L H,CHEUNG H Y S,LI M K W.Advances in laparoscopic colorectal surgery:A review on NOTES and transanal extraction of specimen[J].Asian J Endosc Surg,2014,7(1):11-16.
[27]彭健,丁成明,贾泽民,等.NOSES结直肠癌根治术后腹腔冲洗液肿瘤细胞学检测及细菌培养结果分析[J/CD].中华结直肠疾病电子杂志,2018,7(4):342-346.
[28]COSTANTINO F A,DIANA M,WALL J,et al.Prospective evaluation of peritoneal fluid contamination following transabdominal vs.transanal specimen extraction in laparoscopic left-sided colorectal resections[J].Surg Endosc,2012,26(6):1495-1500.