全胃联合脾切除治疗进展期胃癌的系统评价  

Meta-analysis of total gastrectomy and splenectomy in advanced gastric cancer

作　　者：李鹏[1,2] 何晓东[1,2] 田金徽[1,3] 杨克虎[1,3] 姜雷[1,3] 

机构地区：[1]兰州大学循证医学中心,甘肃省兰州市730000 [2]兰州大学第一医院普外二科,甘肃省兰州市730000 [3]兰州大学基础医学院,甘肃省兰州市730000

出　　处：《世界华人消化杂志》2009年第12期1241-1246,共6页World Chinese Journal of Digestology

摘　　要：目的:系统评价全胃联合脾切除治疗进展期胃癌的有效性及安全性.方法:计算机检索PubMed、EMBase、Cochrane Library、中国生物医学文献数据库、中国期刊全文数据库及中文科技期刊全文数据库,手工检索相关杂志搜集有关全胃联合脾切除(TGS)与全胃切除(TG)两种不同术式治疗进展期胃癌的随机对照试验.按照Cochrane系统评价方法对纳入研究的方法学质量进行评价,用RevMan4.2.10软件进行统计分析.结果:纳入2个随机对照试验共394例患者,各研究基线资料具有可比性,均报道随机方法但未提及盲法和分配隐藏.Meta分析显示,两组1、3、5年生存率和并发症发生率的差异均无统计学意义[OR=0.98、1.41、1.29、1.79,95%CI:(0.61,1.58)、(0.95,2.10)、(0.86,1.29)、(0.98,3.25),P>0.05],但感染性并发症的差异有统计学意义(P<0.05).结论:除非脾脏癌转移或为彻底清扫脾门和脾动脉干阳性淋巴结,应避免在进展期胃癌全胃切除术中联合脾切除.AIM： To assess the efficacy and safety of total gastrectomy and splenectomy versus total gastrectomy in patients with advanced gastric cancer.METHODS： We searched PubMed, Embase, Cochrane Library, Chinese Bio-medicine Database, China journal full-text database, Chinese scientific journals full-text database and manually searched some related randomized controlled trials about total gastrectomy splenectomy （TGS） and total gastrectomy （TG） for advanced gastric cancer in journals. The quality of included studies was assessed according to the Cochrane systematic review method and statistical analysis was performed using RevMan 4.2.10 software RESULTS： Two randomized controlled trials involving 394 patients met the inclusion criteria. All the studies mentioned method of randomization but didn＇t describe the use of blinding and allocated concealment. The baseline of the included study was comparable. The meta-analysis showed that there were no statistically differences between the two groups in 1, 3, 5 year survival rate and complications [OR = 0.98, 1.41, 1.29, 1.79; 95%CI： （0.61, 1.58）, （0.95, 2.10）, （0.86, 1.29）, （0.98, 3.25）, all P 〉 0.05] respectively, but there were statistically differences in infected complications （P 〈 0.05）.CONCLUSION： Splenectomy in advanced gastric cancer patients who receive total gastrectomy should generally be avoided, unless cancer metastatis has reached spleen or in order to thoroughly clear away positive lymphoid node.

关 键 词：进展期胃癌 全胃联合脾切除 系统评价 随机对照试验 

分 类 号：R735.2[医药卫生—肿瘤]