胃上部癌行全胃切除术与近端胃切除术疗效的Meta分析  

Efficacies of total gastrectomy and proximal gastrectomy for the treatment of upper gastric cancer： a Meta analysis

作　　者：刘俊松[1] 车向明[1] 李铎伟[1] 龙厚隆[1] 贺仕才[1] 陈锐[1] 常帅[1] 

机构地区：[1]西安交通大学医学院第一附属医院普通外科,710061

出　　处：《中华消化外科杂志》2013年第7期496-499,共4页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金（81172357）

摘　　要：1目的比较全胃切除术与近端胃切除术治疗胃上部癌的效果。方法通过检索Medline、CochraneLibrary及WebofScience数据库和中国期刊全文数据库、万方数据库，收集国内外1980年1月至2011年10月公开发表的有关胃上部癌手术治疗的英文及中文文献。根据所行手术不同将患者分为近端胃切除术组和全胃切除术组。应用RevMan5．1软件进行Meta分析。二分类变量采用优势比（OR）合并值及95％可信区间（95％CI）表示。结果纳入13篇文献，共2622例胃上部癌患者，其中全胃切除术组1464例，近端胃切除术组1158例。两组患者1年生存率比较，差异无统计学意义（OR=1．23，P〉0．05）；全胃切除术组患者的3、5年生存率显著高于近端胃切除术组（OR=1．74，1．45，P〈0．05）；按TNM分期对5年生存率进行分层分析，两组TNMⅠ、Ⅱ、Ⅳ期患者5年生存率比较，差异无统计学意义（OR=0．94，1．31，2．03，P〉0．05）；但TNMHI期患者中，全胃切除术组患者5年生存率显著高于近端胃切除术组（OR=2．29，P〈0．05）。全胃切除术组患者的总体复发率略低于近端胃切除术组，但差异无统计学意义（OR=0．44，P〉0．05）；其中，全胃切除术组患者的局部复发率低于近端胃切除术组（OR=0．29，P〈0．05）；两组患者的远处复发率比较，差异无统计学意义（OR=0．60，P〉0．05）。结论胃上部癌行全胃切除术的中、远期疗效均优于近端胃切除术；应按照肿瘤的分期个体化地评估手术的价值，指导手术方案的选择。Objective To compare the efficacies of total gastrectomy （TG） and proximal gastrectomy （PG） for patients with upper gastric cancer. Methods Databases including Medline, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang database were searched to retrieve literatures on surgical treatment of upper gastric cancer which were published from January 1980 to October 2011. According to different surgical procedures, all the patients were divided into PG group and TG group. Meta analysis were performed by RevMan 5.1. Categorical variables were presented by odds ratio （OR） and 95% confidence interval （95% CI）. Results Thirteen hteratures including 2622 patients with upper gastric cancer were retrieved. There were 1464 patients in the TG group and 1158 patients in the PG group. There was no significant difference in the 1-year survival rate between the 2 groups （ OR = 1.23, P 〉 0.05 ）. The 3- and 5-year survival rates of patients in the TG group were significantly higher than those of the PG group （ OR = 1.74, 1.45, P 〈 0.05 ）. There were no significant difference in the 5-year survival rates of patients in TNM Ⅰ , Ⅱ, Ⅳ stages between the 2 groups （ OR = 0. 94, 1.31,2. 03, P 〉0.05）, while the 5-year survival rate of patients in TNM Ⅲ stage of TG group was signifi- cantly higher than PG group （ OR = 2. 29, P 〈 0.05）. The overall recurrence rate of TG group was slightly lower than that of PG group, with no significant difference （ OR = 0. 44, P 〉 0. 05）. The local recurrence rate of TG group was significantly lower than that of PG group （ OR = 0. 29, P 〈 0.05 ）. There was no significant difference in the distal recurrence rate between the 2 groups （ OR = 0. 60, P 〉 0.05）. Conclusions The medium and long- term efficacies of TG are superior than that of PG. The stage of cancer should be taken into account to determine the plan of individual treatment.

关 键 词：胃肿瘤 全胃切除术 近端胃切除术 META分析 

分 类 号：R735.2[医药卫生—肿瘤]