进展期胃癌腹腔镜手术对比传统开腹手术近期疗效的Meta分析  

Laparoscopic versus conventional open resection for advanced gastric cancer:a Meta-analysis on short-term outcomes

作　　者：颉宝平[1] 雒芳芳[2] 姚南[3] 

机构地区：[1]天水市第一人民医院外科,甘肃天水741000 [2]天水市第一人民医院妇产科,甘肃天水741000 [3]兰州大学第一医院普外科,甘肃兰州730000

出　　处：《甘肃医药》2014年第10期721-728,共8页Gansu Medical Journal

摘　　要：目的:系统评价腹腔镜胃癌根治术治疗进展期胃癌的临床疗效和安全性。方法:计算机检索CNKI、VIP、WangFang Data、CBM、EMbase、PubMed和Cochrane Library等电子资料库,同时手工检相关文献和会议论文集,检索时间均从建库至2012年6月,查找有关腹腔镜胃癌手术对比传统开腹手术治疗进展期胃癌的所有随机对照试验(Randomized controlled trial,RCT)。按照纳入和排除标准选择文献,对符合标准的RCT,由两位独立研究人员提取资料,并参照Cochrane系统评价员手册5.0.2版质量评价标准对纳入研究的方法学质量进行评估后,采用RevMan5.0软件进行Meta分析。结果:共纳入17个RCT,共计1944例进展期胃癌患者。Meta分析结果显示:与传统开腹手术组相比,腹腔镜手术组的出血量少[加权均数差(weighted mean difference,WMD):-111.05;95%可信区间(confidence interval,95%CI):-146.02,-76.08;P<0.00001]、术后住院时间短(WMD:-2.20;95%CI:-2.82,-1.59;P<0.00001)、术后第一次肛门排气时间短(WMD:-0.91;95%CI:-1.23,-0.59;P<0.00001)、术后第一次进食流质时间短(WMD:-1.01;95%CI:-1.46,-0.56;P<0.00001),但手术时间长(WMD:43.59;95%CI:27.22,59.96;P<0.00001)、清扫淋巴结数量少(WMD:-0.87;95%CI:-2.47,-0.73;P=0.28);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有统计学意义(OR:0.44;95%CI:0.31,0.63;P<0.00001)。结论:与传统开腹胃癌根治术治疗进展期胃癌相比,腹腔镜胃癌根治术可明显减少手术创伤、加快术后恢复、降低术后并发症发生率,推荐结合患者具体情况进行临床应用。Objective：To assess the clinical effectiveness and safety of laparoscopic D2 gastrectomy for advanced gastric cancer.Methods： The databases such as the Chinese Journal Full-text Database, Chinese Scientific Journals Full-text Database, Chinese Biomedicine Database, Chinese Biomedical Literature Database, EMbase ,PubMed, the Cochrane Library were searched by computer from the date of their establishment to June 2012, and the related literatures and conference proceedings were also manually searched to include randomized controlled trials （RCTs） on comparison of laparoscopic with convention,-d open resection for advanced gastric cancer. Studyies were screened according to the inclusion and exclusion criteria,data were extracted, the methodological quality of the included studies were assessed according to Jadad score crite^4on,and meta-analyses were performed with RevMan 5.0 software. Results： A total Of 17 RCTs involving 1944 patients with advanced gastric cancer were enrolled. Comparing laparoscopic gastrectomy with conventional open surgery results showed longer surgery times[（weighted mean difference,WMD）： 43.59;（95% confidence interval,95%CI）： 27.22,59.96; P〈0.00001] and fewer lymph nodes dissected （WMD：-0.87;95%CI：-2.47,-0.73;P=0.28）,but less estimated blood loss （WMD：- 111.05; 95%CI：- 146.02, -76.08; P〈0.00001 ）, shorter durations of hospital stays （ WMD： -2.20; 95 % CI： -2.82, - 1.59; P〈0.00001 ）, earlier postoperative first flatus（WMD： -0.91 ; 95%CI： -1.23, -0.59 ;P〈0.00001 ）and less time to oral intake （WMD：- 1.01 ; 95 % CI： - 1.46, - 0.56;P〈0.00001 ）.Also,the postoperative complication rate was significantly lower with laparoscopic resection （OR：0.44;95%CI： 0.31,0.63;P〈0.00001 ）. Conclusion：The short-term outcome of laparoscopic D2 gastrectomy for patients with advanced gastric cancer is superior to the conventional open surgery, but its long-term outcome should be proven by further outcomes of RCTs.

关 键 词：进展期胃癌 腹腔镜 开腹手术 META分析 系统评价 随机对照试验 

分 类 号：R654.3[医药卫生—外科学]