gnckКолопроктологияKoloproktologia2073-75562686-7303Russian Association of Coloproctology10.33878/2073-7556-2019-18-4-37-85gnck-1518Research ArticleСТАТЬЯ НОМЕРАLEADING ARTICLEОТКРЫТАЯ, ЛАПАРОСКОПИЧЕСКАЯ И ТРАНСАНАЛЬНАЯ МЕЗОРЕКТУМЭКТОМИЯ: СИСТЕМАТИЧЕСКИЙ ОБЗОР ЛИТЕРАТУРЫ И СЕТЕВОЙ МЕТААНАЛИЗ ЭФФЕКТИВНОСТИOPEN, LAPAROSCOPIC AND TRANSANAL TOTAL MESORECTAL EXCISION: A SYSTEMATIC LITERATURE REVIEW AND NETWORK META ANALYSISХильковЮ. C.KhilkovYu. S.

ул. Саляма Адиля, д. 2, Москва, 123423

123423, Moscow, str. Salyama Adilya, 2

yurii.hilkov@mail.ruПономаренкоА. А.PonomarenkoA. A.РыбаковЕ. Г.RybakovE. G.ШелыгинЮ. А.ShelyginYu. A.ФГБУ «ГНЦК им. А.Н. Рыжих» Минздрава РоссииРоссияState Scientific Centre of Coloproctology of the Ministry of Healthcare of RussiaRussian Federation2019211220191843785Copyright © Хильков Ю.C., Пономаренко А.А., Рыбаков Е.Г., Шелыгин Ю.А., 20192019Хильков Ю.C., Пономаренко А.А., Рыбаков Е.Г., Шелыгин Ю.А.Khilkov Y.S., Ponomarenko A.A., Rybakov E.G., Shelygin Y.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ruproctology.com/jour/article/view/1518ВВЕДЕНИЕ

ВВЕДЕНИЕ. На сегодняшний день нет исследований, посвященных сравнению открытой, лапароскопической и трансанальной мезорек-тумэктомии.

ЦЕЛЬ ИССЛЕДОВАНИЯ

ЦЕЛЬ ИССЛЕДОВАНИЯ. Сравнить непосредственные результаты всех методов ТМЭ с помощью метанализа данных.

МАТЕРИАЛЫ И МЕТОДЫ

МАТЕРИАЛЫ И МЕТОДЫ. Систематический обзор выполнен в соответствии с практикой и рекомендациями PRISMA.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. Сорок одна статья была включена в анализ, из которых 14 исследований, посвящены сравнению трансанальной ТМЭ (ТА ТМЭ) (n=480) с лапароскопической ТМЭ (ЛА ТМЭ) (n=5344), 26 исследований – сравнению ЛА ТМЭ с открытой ТМЭ (ОТМЭ) (n=6820) и 1 исследование – сравнению ОТМЭ с ТА ТМЭ. Качество мезоректумэктомии Grade 3 статистически значимо встречалось чаще при ЛА ТМЭ в сравнении с ОТМЭ (ОШ=1,24, ДИ 1.09-1.40, p=0,001), при сравнении ЛА ТМЭ с ТА ТМЭ статистической разницы получено не было (p=0,36). Сетевой метаанализ данных по качеству мезоректумэктомии Grade 3, не выявил статистических различий ни при одном из методов. Позитивная циркулярная граница резекции (ЦГР) отмечается реже при ТА ТМЭ, в сравнении с ЛА ТМЭ (ОШ=2,58, ДИ 1.34-4.97, p=0,005), при сравнении ЛА ТМЭ с ОТМЭ позитивная ЦГР встречалась реже при ЛА ТМЭ (ОШ=0,73, ДИ 0.63-0.85, p<0,0001). По частоте послеоперационных осложнений, сравнивая ЛА ТМЭ с ТА ТМЭ, различий не выявлено (p=0,72), однако при сравнении ЛА ТМЭ с ОТМЭ, их частота статистически значимо меньше в группе ЛА ТМЭ (ОШ=0,75, ДИ 0.68-0.82, p<0,00001). Сетевой метаанализ демонстрирует, что частота послеоперационных осложнений при ЛА ТМЭ меньше, чем при ОТМЭ (ОШ=0,75, ДИ 0,65-0,84).

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ. Методика трансанальной ТМЭ является сопоставимой по эффективности с лапароскопичекой и открытой, а по некоторым параметрам, таким как позитивная ЦГР, качество мезоректумэктомии Grade 1, частота конверсии, послеоперационная задержка мочеиспускания, может давать возможность получать лучшие результаты.

AIM

AIM: to compare the effectiveness of different methods of total mesorectumectomy (TME).

MATERIALS AND METHODS

MATERIALS AND METHODS: the systematic review performed in accordance with PRISMA practice and recommendations.

RESULTS

RESULTS: Forty-one papers were included in the analysis. Fourteen studies were for transanal total mesorectumectomy (TA TME) (n=480) compared with laparoscopic (LA TME), 26 – for LA TME vs open (n=6820), 1 – for open vs TA TME. There was no significant difference between open TME, LA TME and TA TME in grade 3 quality of mesorectumectomy by Quirke. The positive circular resection margin (CRM) is less often in TA TME group, then LA TME (OR=2.58, CI 1.34-4.97, p=0.005). There was significantly lower positive CRM rate in LA TME then open TME (OR=0.73, CI 0.63-0.85, p<0.0001). There were no significant differences in postoperative complications rates between LA TME and TA TME (p=0.72). Network meta-analysis showed less postoperative complications followed LA TME than open TME (OR=0.75, CI 0.65-0.84).

CONCLUSION

CONCLUSION: TA TME is comparable with laparoscopic and open TME in short term results. Rates of positive CRM, the quality of Grade 1 mesorectal excision, the conversion rate, the postoperative urinary dysfunction, may have better results in TA TME.

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The authors declare that there are no conflicts of interest present.