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目的 比较80岁以上患者腹腔镜与开腹结直肠切除术的安全性和有效性.方法 检索Medline、Embase、Ovid和Cochrane数据库中1990-2012年所有对比80岁以上患者腹腔镜和开腹结直肠切除术的文献.将符合文献质量评价标准的文献纳入后,根据研究的异质性分别采用固定效应模型或随机效应模型进行荟萃分析.结果 有5项观察性研究共计685例患者纳入分析,腹腔镜手术组和开腹手术组分别为330例和355例.与开腹手术组相比,腹腔镜手术组手术时间明显延长(WMD=27.89,P＜0.01),总体并发症发生率(OR =0.58,P＜0.01)、切口感染发生率(OR=0.50,P＜0.05)和心血管并发症发生率(OR=0.53,P＜0.05)明显降低,术后肠功能恢复时间(WMD=-0.83,P＜0.01)和住院时间(WMD=-3.60,P＜0.05)明显缩短;两组在吻合口瘘、呼吸道并发症发生率、围手术期病死率以及围手术期再手术率方面的差异无统计学意义(均P＞0.05).结论 80岁以上患者腹腔镜结直肠切除术是安全、可行的,其在住院时间和术后肠功能恢复方面更是优于开腹手术.

Objective To compare the clinical safety and efficacy of laparoscopic versus open colorectal resection in octogenarians.Methods Studies comparing laparoscopic colorectal resection with open colorectal resection in octogenarians were identified from the Medline, Embase, Ovid, and Cochrane databases from 1990 to 2012.The methodological quality of the selected studies was assessed to determine studies suitable for inclusion.Meta-analysis was performed by fixed or random effects model.Results Five observational studies with a total of 685 patients (330 laparoscopic colorectal resections and 355 open colorectal resections) were identified.Laparoscopic colorectal resection was associated with a prolonged operative time (WMD =27.89,P＜0.01) and a lower rate of overall complications (OR=0.58,P＜0.01 ),wound infection (OR=0.50,P＜0.05),cardiovascular complication (OR=0.53,P＜0.05),quicker bowel function return (WMD=-0.83,P＜0.01),and shorter length of hospital stay (WMD=-3.60,P＜0.05).No differences were found with rcgard to anastomotic leak (OR=1.13,P＞0.05),prolonged ileus (OR =0.71,P＞0.05),respiratory complication (OR =0.59,P＞0.05),mortality (OR=0.67,P＞0.05),and reoperation (OR=0.85,P＞0.05).Conclusion Laparoscopic colorectal resection is as safe as open colorectal resection,and is more favorable in terms of length of hospital stay and bowel function return in octogenarians.