摘要目的 系统性评价腹腔镜直肠癌前切除术中肠系膜下动脉的高位结扎与低位结扎的手术效果.方法 以“直肠癌”“左结肠动脉”“腹腔镜”“rectal neoplasms"“rectal cancer"“laparoscop"“LCA”“IMA”等为检索词,采用自由词与主题词相结合的方式,检索期限设定为从建库开始至2017年3月,检索Pubmed、The cochrane Library、Embase、万方数据库、中国知网数据库,并手工检索未公开发表的文献.收集腹腔镜直肠癌前切除术中高位结扎与低位结扎肠系膜下动脉两种血管结扎方式相比较的随机对照试验及临床对照试验,由2位研究员独立进行文献筛查、数据提取及文献质量的评价等,应用STATE 12.0软件进行Meta分析.对连续性资料计算标准化均数差(SMD)、二分类资料计算比值比(OR),并计算各效应量的点估计值及95％ CI.采用I2检验法对所纳入的文献进行异质性检验:若异质性小,采用固定效应模型;否则采用随机效应模型.异质性较大则应用敏感性分析或亚组分析的方法进一步探索异质性来源,处理异质性.结果 共15篇文献,含16篇研究被纳入.Meta分析结果显示:低位结扎组与高位结扎组相比吻合口瘘发病率下降(OR=0.394,95％ CI:0.251 ～0.616,P=0.000);手术时间延长(SMD=0.361,95％ CI:0.242 ～0.480,P=0.000);而肠系膜下动脉根部淋巴结清扫数量(SMD=-0.017,95％ CI:-0.130～0.097,P=0.772)、术中出血量(SMD=0.083,95％ CI:-0.048～0.214,P=0.213)等方面差异无统计学意义.结论 保留左结肠动脉虽然手术时间延长,但可降低吻合口瘘的发病率,在肠系膜下动脉根部淋巴结清扫数目、术中出血量等方面与高位结扎组差异无统计学意义,可在临床中推广应用.

abstractsObjective To evaluate the surgical effect of laparoscopic anterior resection of rectal carcinoma with or without the left colic artery.Methods Through computer searching PubMed,Cochrane Library,Embase,WanFang Date and CNIK Date.Handsearching the Gray literature simultaneously.The randomized controlled trails and clinical controlled trials comparing low ligation with high ligation the inferior mesenteric artery in laparoscopic anterior resection of rectal carcinoma were colected.Data were screened,extracted and evaluated by two reviewers independently.Meta-analyses were conducted using the sofeware STATE12.0.The standardized mean difference were calculated for continuous data and odds ratio for dichotomous and the point estimates of each effect quantity and 95％ confidence interval were calculated.TheI2 test was used to test the heterogeneity of the inchuded literature:if the heterogeneity was small,the fixed effects model was adopted.otherwise,the random effects models was adopted and explored the heterogeneity by sensitivity analysis or subgroup analysis.Results Forteen articles including 15 researches were met the selection criteria.The Meta-analyses showed that the grope of low ligation had lower rate of anastomotic fistula (OR =0.394,95 ％ CI:0.251-0.616,P =0.000) and longer opration time (SMD =0.361,95％CI:0.242-0.480,P =0.000).There is no statistical differences in the number of lymph node dissection besides the root of IMA (SMD =-0.017,95％ CI:-0.130-0.097,P =0.772) intraoperative biood loss (SMD =0.083,95 ％ CI:-0.048-0.214,P =0.213).Conclusions In spite of reserved the left colic artery had longer operation time it can reducedrate of anastomotic fistula effectively and there is no statistical differences in the number of lymph node dissection besides the root of IMA,intraoperative blood loss.It is possible to promote the use of reserved the left colic artery in laparoscopic anterior resection of rectal carcinoma.