Эффективность и безопасность гибридных лапароэндоскопических операций при опухолях ободочной кишки (систематический обзор литературы и метаанализ)

Цель: сравнить эффективность и безопасность гибридных лапаро-эндоскопических операций и лапароскопических сегментарных резекций ободочной кишки в лечении пациентов с доброкачественными колоректальными новообразованиями, не подлежащими эндоскопическому удалению.

Материалы и методы: выполнен систематический обзор и метаанализ 17 клинических исследований, оценивающих результаты применения гибридных лапаро-эндоскопических вмешательств (основная группа) и лапароскопических резекций ободочной кишки (контрольная группа). В исследование включено 835 пациентов, в основную группу — 517 пациентов, в контрольную — 318.

Результаты: длительность операции оказалась статистически значимо меньше в группе гибридных лапаро-эндоскопических вмешательств, в сравнении с лапароскопическими сегментарными резекциями толстой кишки (Разница средних = −38,7 минут; 95% ДИ −51,4 — −26,0; р < 0,00001), равно как и длительность послеоперационного койко-дня (Разница средних = −2,3 дней; 95% ДИ −3,17 — −1,57; р < 0,00001). Вероятность развития послеоперационных осложнений (ОШ = 0,7; 95% ДИ 0,38–1,53; р = 0,44), летальности (ОШ = 0,4; 95% ДИ 0,07–3,11; р = 0,43) и частоты возникновения местных рецидивов (ОШ = 2,8; 95% ДИ 0,68–11,35; р = 0,15) между группами статистически значимо не различалась.

Заключение: выполнение гибридных лапаро-эндоскопических операций у больных с доброкачественными неудалимыми эндоскопически новообразованиями ободочной кишки не увеличивает частоту послеоперационных осложнений и летальность. В тоже время, применение этой технологии способствует сокращению операционного времени и сроков послеоперационного пребывания больных в стационаре.

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