D3淋巴结清扫术在胃癌术中应用的疗效和安全性Meta分析  

Efficacy and Safety of D3 Lymph Node Dissection in Patients with Advanced Gastric Cancer:A Meta-analysis

作　　者：张璐[1] 张宇龙[1] 吴佳[1] 韩伟[1] 石碗如[1] 张有成[1] 

机构地区：[1]兰州大学第二医院普通外科,甘肃省兰州市730030

出　　处：《中国全科医学》2011年第18期2004-2007,共4页Chinese General Practice

摘　　要：目的评价D3淋巴结清扫术治疗进展期胃癌的临床疗效与安全性。方法以胃癌(gastric cancer)、D2淋巴结清扫术(D2 lymph node dissection)、D3淋巴结清扫术(D3 lymph node dissection)等检索词分别以主题词和自由词全面检索Cochrane图书馆(2010年第2期)、PubMed及EMBASE,同时检索中国生物医学文献数据库(CBM)、中国学术期刊全文数据库(CNKI)、中文科技期刊数据库(VIP)和万方数据库。检索时间截止于2010年4月。由2名评价者独立评价并交叉核对纳入研究的质量,对同质研究采用RevMan5.0软件进行Meta分析。结果共纳入研究5个,1个随机对照试验,4个非随机对照试验,包括1 685例患者。D2、D3淋巴清扫术治疗进展期胃癌,5年生存率、术后病死率、术后吻合口瘘发生率、术后肺炎发生率间差异无统计学意义;而D3淋巴结清扫术后胰瘘的发生率显著高于D2淋巴结清扫术,差异有统计学意义[OR=2.26,95%CI(1.12,4.54)]。结论鉴于纳入研究在方法学上的局限性,本文尚不足以论证两种术式的疗效和安全性以何者为优。Objective To assess the efficacy and safety of D3 lymph node dissection in patients with advanced gastric cancer.Methods We searched the electronic bibliographic databases,including the Cochrane library（2010-2）,PubMed,EMBASE,CBM,VIP,CNKI and WANFANG with the keyword and free terms of ＂gastric cancer,D2 lymph node dissection,D3 lymph node dissection＂.The deadline retrieval time was April 2010.The quality of data was cross-checked and evaluated by two reviewers independently.RevMan5.0 software was used for data analysis among homogeneous studies.Results A total of 5 studies,1 randomized controlled trial and 4 non-randomized controlled trial,involving 1 685 patients were included.No significant differences between the D2 lymph node dissection group and the D3 lymph node dissection group in terms of 5-year survival rate,postoperative mortality,incidence of postoperative anastomotic leakage and pneumonia,whereas incidence of pancreatic leakage increased significantly among the D3 lymph node dissection group,compared to the D2 lymph node dissection group[OR=2.26,95%CI（1.12,4.54）].Conclusion In view of the limitations in the methodology of included studies,the efficacy and safety of D2 and D3 lymph node dissection for patients with advanced gastric cancer have yet to be accurately assessed.

关 键 词：D3淋巴结清扫 胃肿瘤 META分析 

分 类 号：R735.2[医药卫生—肿瘤]