我国腹腔镜D2淋巴结清扫术联合远端胃癌切除术治疗进展期远端胃癌安全性和疗效的系统评价  

Safety and Effectiveness of Laparoscopy-Assisted Distal Gastrectomy with D2 Lymph Node Dissection for Distal Gastric Cancer of Chinese Patients:A Systematic Review

作　　者：毛婧[1] 马继春[1] 姜雷[2] 常航[1] 朱伟鹏[1] 扈晓东 汪晓炜[2] 

机构地区：[1]兰州大学第一临床医学院,甘肃兰州730000 [2]兰州大学第一医院肿瘤外科,甘肃兰州730000

出　　处：《中国普外基础与临床杂志》2014年第6期707-715,共9页Chinese Journal of Bases and Clinics In General Surgery

基　　金：2013年兰州大学中央高校基本科研业务费专项基金资助项目(项目编号:lzujbky-2013-160)~~

摘　　要：目的系统评价我国腹腔镜D2淋巴结清扫术联合远端胃癌切除术治疗进展期远端胃癌的有效性和安全性。方法计算机检索PubMed数据库、Cochrane图书馆、中国科学引文数据库(China science citation database,CSCD)、万方数据库(Wanfang)、中文科技期刊数据库(China science and technology journal database,CSTJ)、中国生物医学文献数据库(China biomedical literature database,CBM)和中国学术期刊网络出版总库(China academic journal network publishing database,CAJD)数据库,检索时限均从建库至2013年6月。采用Review Manager 5.2软件进行Meta分析。结果最终纳入了7个临床随机对照试验,共548例进展期胃癌患者。Meta分析结果显示:与传统开放式远端胃癌切除术(CODG)相比,腹腔镜辅助远端胃癌切除术(LADG)的术中出血量少(MD=-94.02,95%CI:-140.96^-47.07)、术后住院时间短(MD=-3.66,95%CI:-5.76^-1.57)、术后下床活动时间早(MD=-1.95,95%CI:-2.74^-1.17)、肛门排气时间早(MD=-1.67,95%CI:-2.05^-1.30)、总并发症发生率低(OR=0.26,95%CI:0.14~0.51),差异均有统计学意义(P<0.050),但LADG组的手术时间长于CODG组(MD=35.01,95%CI:10.41~59.61,P=0.005)。2组间淋巴结清扫数量比较差异无统计学意义(MD=-0.24,95%CI:-0.99~0.51,P=0.530)。结论 LADG的近期疗效及安全性均优于传统CODG,但其手术时间长,远期疗效尚需进一步探究。Objective To systemically evaluate safety and effectiveness of laparoscopy-assisted distal gastrectomy（LADG） and conventional open distal gastrostomy （CODG） with D2 lymph node dissection for Chinese patients with distal gastric cancer. Methods Literature were searched in PubMed database, the Cochrane Library, China science citation database （CSCD）, Wanfang database, China science and technology journal database （CSTJ）, China biomedical literature database （CBM）, and China academic journal network publishing database （CAJD） to identify clinical random controlled trials, comparing safety and effectiveness of LADG and CODG with D2 lymph node dissection for Chinese patients with distal gastric cancer. The retrieval time was from the inception to Jun. 2013. Meta-analysis was performed by Review Manager 5.2 software. Results A total of 7 clinical random controlled trials including 548 patients were analyzed. Compared with CODG group, LADG group had less blood loss （MD =-94.02, 95% CI：-140.96- -47.07）, shorter postoperative hospital stay （MD =-3.66, 95% CI：-5.76- -1.57）, earlier postoperative ambulation time （MD =-1.95,95% CI：-2.74- -1.17）, earlier postoperative exhaust time （MD =-1.67, 95% CI：-2.05- -1.30）, lower incidence of complications （OR=0.26, 95% CI：0.14-0.51）, P〈0.050. But the operation time was longer in LADG group（MD =35.01, 95% CI：10.41-59.61, P=0.005）. There was no significant difference between LADG group and CODG group on number of lymph node which were dissected during the operation （MD =-0.24, 95% CI：-0.99-0.51, P=0.530）. Conclusion The short-term outcome and safety of LADG for Chinese patients with distal gastric cancer is superior to CODG, but LADG prolongs the operation time and its long-term outcome should be proved by further outcomes of clinical controlled trials.

关 键 词：腹腔镜 开腹手术 D2淋巴结清扫术 远端胃癌 系统评价 

分 类 号：R735.2[医药卫生—肿瘤]