微创手术与普通开胸手术治疗食管癌的疗效和安全性的Meta分析  

Minimally Invasive Surgery Compared with Traditional Surgery for Esophageal Cancer:A Meta Analysis

作　　者：王志强[1] 张建华[1] 王成[1] 李斌[1] 苟云久[1] 

机构地区：[1]兰州大学第二医院胸外科,兰州700030

出　　处：《循证医学》2013年第5期300-306,共7页The Journal of Evidence-Based Medicine

摘　　要：目的探讨微创手术用于食管癌患者的临床疗效和安全性。方法计算机检索Cochrane图书馆(2012年第4期)、PubMed、EMBASE、CBM、CNKI、VIP、万方(截至2012年12月)数据库。收集食管癌微创手术的随机对照试验,采用Cochrane系统评价的方法,提取数据并由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RevMan 5.0软件进行Meta分析。结果共纳入7个随机对照试验包括431例患者。Meta分析结果显示:①微创手术与开胸手术在术后生存率、复发率和术后死亡率方面并无差异;②微创手术组的术中出血量明显低于普通开胸手术[加权均数差=-175.33 mL,95%可信区间(-195.57,-155.09)mL];③微创手术组患者的手术时间与普通开胸手术无差异;④微创手术组患者的住院时间明显短于普通开胸手术组[加权均数差=-9.14天,95%可信区间(-16.09,-2.19)天];⑤虽然微创手术与普通开胸手术在在胸部、消化道相关并发症以及肺水肿和肺栓塞方面两组之间的差异并无统计学意义,但微创手术可以明显减少术后肺部感染、吻合口瘘以及声带麻痹的并发症,而且术后肺功能明显优于普通开胸手术组。结论微创手术组可以明显减少术中出血量,缩短术后住院时间,减少术后肺部感染及术后总并发症发生率,促进术后肺功能的恢复;但远期疗效仍需要大样本随机对照研究进一步探索。Objectives To evaluate the clinical efficacy and safety of minimally invasive surgery for esophageal cancer. Methods We searched the electronic bibliographic databases, including The Coehrane Library, PubMed, EMBASE, CBM, CNKI, VIP and Wanfang databases to assemble the randomized controlled trials （RCTs） of minimally invasive surgery for esophageal cancer. The deadline of the retrieval time was December 2012. Data were extracted and evaluated by two reviewers independently with a designed extraction form. The RevMan 5.0 software was used for meta-analysis on homogeneous studies. Results 7 clinical trials involving 431 patients were included. The results of meta-analysis showed： ① There was no significant difference between the two groups in the respect of survival rate, recurrence rate and mortality after surgery; ② Minimally invasive surgery could reduce intraoperative bloodloss[WMD=-175.33 mL, 95%CI（-195.57, -155.09） mL]; ③There was no significant difference between the two groups in the respect of operating time; ④ Minimally invasive surgery could shorten hospital stay [WMD =-9.14 days, 95%CI（-16.09, -2.19） days]; ⑤ Minimally invasive surgery could reduce the rate of pulmonary infection, anastomotic leakage and vocal cord paralysis; And lung function in minimally invasive surgery was better than traditional thoracotomy. Conclusion Evidences showed that minimally invasive surgery could decrease intraoperative bloodloss, the time of postoperative stay, the rate of pulmonary infection, anastomotic leakage and vocal cord paralysis. Further RCT is still needed to evaluate the long-term clinical efficacy of minimally invasive surgery.

关 键 词：食管癌 微创外科 随机对照试验 META分析 

分 类 号：R735.1[医药卫生—肿瘤]