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Колопроктология

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ОТКРЫТАЯ, ЛАПАРОСКОПИЧЕСКАЯ И ТРАНСАНАЛЬНАЯ МЕЗОРЕКТУМЭКТОМИЯ: СИСТЕМАТИЧЕСКИЙ ОБЗОР ЛИТЕРАТУРЫ И СЕТЕВОЙ МЕТААНАЛИЗ ЭФФЕКТИВНОСТИ

https://doi.org/10.33878/2073-7556-2019-18-4-37-85

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Аннотация

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

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

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

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. 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.

Об авторах

Ю. C. Хильков
ФГБУ «ГНЦК им. А.Н. Рыжих» Минздрава России
Россия

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



А. А. Пономаренко
ФГБУ «ГНЦК им. А.Н. Рыжих» Минздрава России
Москва


Е. Г. Рыбаков
ФГБУ «ГНЦК им. А.Н. Рыжих» Минздрава России
Москва


Ю. А. Шелыгин
ФГБУ «ГНЦК им. А.Н. Рыжих» Минздрава России
Москва


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Для цитирования:


Хильков Ю.C., Пономаренко А.А., Рыбаков Е.Г., Шелыгин Ю.А. ОТКРЫТАЯ, ЛАПАРОСКОПИЧЕСКАЯ И ТРАНСАНАЛЬНАЯ МЕЗОРЕКТУМЭКТОМИЯ: СИСТЕМАТИЧЕСКИЙ ОБЗОР ЛИТЕРАТУРЫ И СЕТЕВОЙ МЕТААНАЛИЗ ЭФФЕКТИВНОСТИ. Колопроктология. 2019;18(4):37-85. https://doi.org/10.33878/2073-7556-2019-18-4-37-85

For citation:


Khilkov Yu.S., Ponomarenko A.A., Rybakov E.G., Shelygin Yu.A. OPEN, LAPAROSCOPIC AND TRANSANAL TOTAL MESORECTAL EXCISION: A SYSTEMATIC LITERATURE REVIEW AND NETWORK META ANALYSIS. Koloproktologia. 2019;18(4):37-85. https://doi.org/10.33878/2073-7556-2019-18-4-37-85

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ISSN 2073-7556 (Print)
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