胸腔镜腹腔镜联合手术与开放手术治疗食管癌的Meta分析  

Thoracolaparoscopic esophagectomy versus open esophagectomy： A meta-analysis of outcomes

作　　者：陈亮[1] 王武军[1] 蔡瑞君[1] 

机构地区：[1]南方医科大学南方医院心胸血管外科,广州510515

出　　处：《中华胃肠外科杂志》2012年第6期603-607,共5页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的系统评价胸腔镜腹腔镜联合与开放手术食管切除治疗食管癌的疗效及安全性。方法检索Pubmed、Embase、Cochrane图书馆资料库、Google学术搜素、中国生物医学文献数据库及中国期刊全文数据库：检索时间范围均为建库至2011年7月。收集比较胸腔镜腹腔镜联合手术与开放手术治疗食管癌的随机对照试验和非随机对照试验。由两名研究者按Cochrane系统评价方法来筛选文献、评价质量、提取资料，并用RevMan5．1软件进行Meta分析。结果纳入10个临床对照试验共1017例样本。其中455例行胸腔镜腹腔镜联合手术。562例行开放手术。Meta分析结果显示。两组患者术后吻合口瘘发生率、围手术期死亡率及淋巴结清扫数目3项主要结局指标的差异均无统计学意义（均P〉0．05）。对于10项次要结局指标的Meta分析结果显示，胸腔镜腹腔镜联合组患者手术时间更短、术中出血量更少、术后呼吸道并发症发生率更低（均P〈0．05）；两组患者总并发症、心脏并发症、吻合口狭窄、喉返神经损伤、住院时间、ICU停留时间及术后3年生存情况的差异均无统计学意义（均P〉0．05）。结论胸腔镜腹腔镜联合手术可以达到开放手术治疗食管癌的疗效及安全性。Objective To evaluate the outcomes of thoracolaparoscopic esophagectomy venus open esophagectomy for esophageal cancer. Methods Literature search was performed using PubMed, Embase, Coehrane Library, and Google Scholar databases, CBM, and CNKI from inception to July 2011 for comparative studies assessing thoracolaparoscopie esophagectomy and open esophagectomy. Data were extracted and evaluated by two reviewers independently according to the Cochrane Handbook for Systematic Reviews. Meta-analyses were conducted using RevMan 5.1. Results A total of 10 studies involving 1017 patients were included for the analysis. Four hundred and fifty-five patients underwent thoracolaparoscopie esophagectomy and 562 patients underwent open esophagectomy. There were no significant differences between the two groups in anastomotic leak, 30-day mortality, and number of lymph node retrieved （P〉0.05）. However, thoracolaparoscopie esophagectomy had lower blood loss, less operative time, and reduced respiratory complications （P〈0.05）. There were no significant differences between the two groups in overall complications, cardiac complications, anastomotic stricture, recurrent laryngeal nerve injury, length of stay, ICU stay, and 3-year survival （all P〉0.05）. Conclusion Thoraeolaparoscopic esophagectomy for esophageal cancer is feasible and safe as open esophagectomy.

关 键 词：食管肿瘤 食管切除术 胸腔镜 腹腔镜 META分析 

分 类 号：R735.1[医药卫生—肿瘤]