3D和2D腹腔镜手术治疗胃肠道癌症患者的短期预后比较

doi:10.3760/cma.j.cn441417-20240913-06005

摘要/Abstract

摘要：

目的　系统评价二维（two dimension，2D）和三维（three dimension，3D）腹腔镜手术治疗胃肠道癌症患者的短期预后，为2D和3D腹腔镜手术治疗胃肠道癌症患者的临床实践提供循证依据。方法　检索PubMed、EMbase、The Cochrane Library、中国知网、万方数据库、维普，搜集比较2D和3D腹腔镜手术治疗胃肠道癌症患者短期预后的中英文文献，检索时限从建库至2024年7月31日，提取文献中短期预后相关资料；质量评价采用Cochrane偏倚风险评估工具，并采用RevMan 5.4.1软件进行meta分析。结果　本研究纳入2014—2021年发表文献18篇，其中胃癌12篇，直肠癌2篇，结肠癌1篇，结直肠癌3篇，纳入样本量共2 100例。meta分析结果显示，3D腹腔镜手术治疗胃肠道癌症患者的手术时间短于2D腹腔镜手术［MD=20.91（95%CI 9.44～32.37），Z=3.57，P<0.001］；3D腹腔镜手术治疗胃肠道癌症患者术中出血量少于2D腹腔镜手术［MD=7.31（95%CI 6.03～8.60），Z=11.19，P<0.001］；3D腹腔镜手术治疗胃肠道癌症患者淋巴结清扫数目多于2D腹腔镜手术［MD=-0.83（95%CI -1.26～-0.40），Z=3.82，P<0.001］；2D和3D腹腔镜手术治疗胃肠道癌症患者排气时间、住院时间、术后并发症差异均无统计学意义（均P>0.05）。异质性检验结果显示，各文献中2D和3D腹腔镜手术治疗胃肠道癌症患者术中出血量、淋巴结清扫数目、排气时间、住院时间、术后并发症均无异质性（均I²<50%），手术时间存在异质性（I²=93%）；基于癌症类型将患者分为两组进行亚组分析，结果显示，不同癌症类型患者2D和3D腹腔镜手术时间差值仍存在异质性（胃癌I²=91%，结直肠癌I²=87%）。结论　2D和3D腹腔镜手术治疗胃肠道癌症患者可获得相似的短期预后。与2D腹腔镜手术相比，3D腹腔镜手术时间更短，术中出血量更少，且可清扫出更多淋巴结，但可能需要承担更高的治疗费用，临床可根据患者实际情况，选择合适方式。

关键词:

胃肠道癌症, 2D/3D腹腔镜手术, 短期预后, meta分析

Abstract:

Objective　To systematically evaluate the short-term prognosis of two dimension (2D) and three dimension (3D) laparoscopic surgery for patients with gastrointestinal cancers, and to provide evidence-based basis for clinical practice of 2D and 3D laparoscopic surgery for patients with gastrointestinal cancers. Methods　PubMed, EMbase, The Cochrane Library, China Knowledge Network, Wanfang Database, and VIP were searched for Chinese and English literature on the comparison of short-term prognosis of patients with gastrointestinal cancers treated by 2D and 3D laparoscopic surgery from their establishment to 31 July 2024, and the information related to short-term prognosis in the literature was extracted. The quality evaluation was performed using the Cochrane Risk of Bias Assessment Tool. Meta-analysis was performed using the RevMan 5.4.1 software. Results　In this study, 18 articles published from 2014 to 2021 were included, including 12 articles on gastric cancer, 2 articles on rectal cancer, 1 article on colon cancer, and 3 articles on colorectal cancer, with a total sample size of 2 100 cases.The results of the meta-analysis showed that the operation time of 3D laparoscopic surgery for gastrointestinal cancers was shorter than that of 2D laparoscopic surgery (MD=20.91; 95%CI 9.44-32.37; Z=3.57; P<0.001)]; the intraoperative bleeding volume in 3D laparoscopic surgery for gastrointestinal cancers was less than that in 2D laparoscopic surgery (MD=7.31; 95%CI 6.03-8.60; Z=11.19; P<0.001); the number of lymph nodes cleared in 3D laparoscopic surgery for gastrointestinal cancers was more than that in 2D laparoscopic surgery (MD=-0.83; 95%CI -1.26--0.40; Z=3.82; P<0.001); there were no statistical differences between 2D and 3D laparoscopic surgery for gastrointestinal cancers in terms of time to defecation, length of hospital stay, and postoperative complications (all P>0.05). The results of the heterogeneity test showed that there was no heterogeneity in intraoperative bleeding volume, number of lymph node dissection, time to exhaustion, hospital stay, and postoperative complications between 2D and 3D laparoscopic surgery for the patients with gastrointestinal cancers across the literature (all I²<50%); there was heterogeneity in the operation time (I²=93%). The patients were classified into 2 subgroups based on the types of cancer, and the results showed that there was heterogeneity in operation time between 2D and 3D laparoscopic surgery for patients with different types of gastrointestinal cancers (I²=91% for gastric cancer and I²=87% for colorectal cancer). Conclusions　2D and 3D laparoscopic surgery for patients with gastrointestinal cancers can achieve similar short-term prognosis. Compared with 2D laparoscopic surgery, 3D laparoscopic surgery has shorter operation time, less intraoperative bleeding volume, and more lymph nodes cleared out, but it has higher treatment cost, so the clinic can choose an appropriate method for the treatment of a patient according to his or her actual situation.

Key words:

Gastrointestinal cancers, 2D/3D laparoscopic surgery, Short-term prognosis, Meta-analysis

于明英李媛燕普.

3D和2D腹腔镜手术治疗胃肠道癌症患者的短期预后比较 [J]. 国际医药卫生导报, 2025, 31(6): 900-907.

Yu Mingying, Li Yuan, Yan Pu.

Short-term prognosis of 3D versus 2D laparoscopic surgery for patients with gastrointestinal cancers [J]. International Medicine and Health Guidance News, 2025, 31(6): 900-907.

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