目的：系统评价手辅助腹腔镜手术（HALS）与腹腔镜辅助手术（LAS）治疗结直肠癌的临床疗效。方法：计算机检索国内外多个数据库，收集有关比较HALS与LAS治疗结直肠癌疗效的随机对照试验与非随机对照研究，按纳入标准筛选后进行质量评分，提取数据，采用RevMan 5.3软件行Meta 分析。结果：最终纳入27篇研究，共3 347例患者，其中HALS组1 626例，LAS组1 721例。Meta分析结果显示，与LAS组比较，HALS组手术时间短（WMD=-24.18，95% CI=-31.61~-16.75）、中转率（OR=0.57，95% CI=0.41~0.81）和术中损伤率低（OR=0.48，95%CI=0.29~0.78）、使用Trocar少，但切口长度增加（WMD=1.07，95% CI=0.64~1.50），差异均有统计学意义（均P<0.05）。两组在术后恢复、术后并发症、肿瘤学指标、随访结果、术后疼痛以及住院费用等方面的差异均无统计学意义（均P>0.05）。结论：HALS结合了LAS微创和开腹手术直观的优点，可作为结直肠癌微创手术的一个选择。
Hand-assisted laparoscopic surgery versus laparoscopic-assisted surgery for colorectal cancer: a Meta-analysis
Objective: To systematically assess the clinical efficacy of hand-assisted laparoscopic surgery (HALS) and laparoscopic-assisted surgery (LAS) in treatment of colorectal cancer. Methods: The randomized controlled trials and non-randomized comparative studies comparing HALS and LAS for colorectal cancer were collected by searching several national and international databases. After screening for inclusion, quality assessment and data extraction, Meta-analysis was performed by the RevMan 5.3 software. Results: A total of 27 studies involving 3 347 patients were finally included, with 1 626 cases in HALS group and 1 721 cases in LAS group. Results of Meta-analysis showed that in HALS group compared with LAS group, the operative time (WMD=–24.18, 95% CI=–31.61––16.75) was shortened, conversion rate (OR=0.57, 95% CI=0.41–0.81) and incidence of intraoperative injuries (OR=0.48, 95% CI=0.29–0.78) were decreased, the number of trocars used was reduced, but the length of incision (WMD=1.07, 95% CI=0.64–1.50) was increased, and all differences had statistical significance (all P<0.05). There was no statistically significant difference between the two groups in terms of postoperative recovery, incidence of postoperative complications, oncological outcomes, follow-up results, postoperative pain and hospitalization costs (all P>0.05). Conclusion: HALS can be considered as an alternative for colorectal cancer, which combines the advantages of minimal invasiveness of LAS and direct view of open surgery.