早期胃癌腹腔镜辅助远端胃切除术疗效评价的Meta分析  

Meta analysis of Laparoscopy-assisted Distal Gastrectomy and Conventional Open Distal Gastrectomy for Early Gastric Cancer

作　　者：王越[1] 王嵩[2] 梁建国[3] 郝继英[4] 葛金年[5] 侴伟平[1] 

机构地区：[1]辽宁省肿瘤医院麻醉科,辽宁沈阳110042 [2]沈阳市环境保护局 [3]邯郸市第一医院麻醉科 [4]冀中能源峰峰集团有限公司总医院麻醉科 [5]沈阳医学院奉天医院普外科

出　　处：《华南国防医学杂志》2013年第1期56-61,共6页Military Medical Journal of South China

摘　　要：目的评价腹腔镜辅助远端胃切除术(laparoscopy-assisted distal gastrectomy,LADG)与传统开腹手术(con-ventional open distal gastrectomy,CODG)治疗早期胃癌的临床疗效和安全性。方法检索PubMed、EmBase、临床对照试验资料库(cochrane controlled trials register,CCTR)及中国生物医学数据库(Chinese biomedical literature database,CBM)发表的临床随机对照研究文献,对纳入研究的文献采用Newcastle-Ottawa量表进行质量评价。提取文献原始数据,采用Revman 5.0统计软件对数据进行Meta分析,计算合并OR值和95%可信区间。结果经筛选有8个随机对照试验(ran-domized controlled trials,RCT)共734例患者纳入系统评价。与开腹手术组相比,腹腔镜手术组手术时间长,加权均数差(weighted mean difference,WMD)63.35;95%可信区间(confidence interval,95%CI)[57.96,68.74];P<0.00001)。出血量少(WMD:-127.95;95%CI[-147.97,-107.93];P<0.00001)。清扫淋巴结数量少(WMD:-4.21;95%CI[-6.10,-2.31];P<0.0001),术后肠道功能恢复快(WMD:-0.43;95%CI[-0.61,-0.24];P<0.00001),住院时间短(WMD:-1.29;95%CI[-1.76,-0.83];P<0.00001)。腹腔镜手术组术后并发症发生率与开腹手术组之间的差异无统计学意义(OR:0.70;95%CI[0.46,1.06];P=0.09)。结论早期胃癌LADG可减少术中出血和术后并发症,但却增加了手术时间,减少了淋巴结的清扫数量;远期效果尚需进一步的RCT研究证实。Objective To evaluate the safety and effectiveness of the laparoscopy-assisted distal gastrectomy（LADG） and conventional open distal gastrectomy（CODG） for patients with early gastric cancer（EGC）.Methods The related randomized controlled trial（RCT） literatures in PubMed,EmBase,cochrane controlled trials register（CCTR） and Chinese biomedical database（CBM） were searched and evaluated using the Newcastle-Ottawa Scale.The original materials were extracted to perform meta-analysis,pooled odd ratio（OR）and 95% confidence intervals（CI） were calculated using RevMan 5.0.Results A total of 8 RCTs including 734 patients were included for meta-analysis.Compared with CODG,the surgical time of LADG was longer with weighted mean difference（WMD） 63.35 and 95% CI [57.96,68.74],P0.01.The intraoperative blood loss amount was fewer with WMD-127.95 and 95% CI [-147.97,-107.93],P〈0.00001.The number of harvested lymph nodes was fewer with WMD-4.21 and 95% CI [-6.10,-2.31],P0.0001.The postsurgery intestinal function was recovered faster with WMD-0.43 and 95% CI [-0.61,-0.24],P〈0.00001.The inhospital stay was shorter with WMD-1.29 and 95% CI [-1.76,-0.83],P〈0.00001.There was no significant difference between two groups in the incidence of postoperative complications（OR：0.70;95% CI [0.46,-1.06];P=0.09）.Conclusion LADG can decrease the intraoperative blood loss and postoperative complica tions of patients with,but increase the operation time and decrease the number of harvested lymph nodes.Its long-term efficacy should be further stud ied by RCTs.

关 键 词：胃癌 腹腔镜胃切除术 META分析 

分 类 号：R735.2[医药卫生—肿瘤]