全腹腔镜与腹腔镜辅助胃癌根治术治疗胃癌的近期疗效对比Meta分析  

Comparison of short-term clinical outcomes between totally laparoscopic and laparoscopic assisted gastrectomy for gastric cancer:A Meta analysis

作　　者：刘芳腾 朱培谦[1] 夏广丰 邱铖 张翼[1] 郝腾飞[1] 罗洪亮[1] 

机构地区：[1]南昌大学第二附属医院胃肠外科,江西南昌330000

出　　处：《中华肿瘤防治杂志》2016年第9期610-616,共7页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的近年来,全腹腔镜远端胃癌根治术(totally laparoscopic distal gastrectomy,TLDG)治疗胃癌的报道日益增多,手术疗效也备受关注。本研究从循证医学角度分析TLDG治疗胃癌的近期疗效。方法检索收集截至2015-11发表的比较TLDG和腹腔镜辅助远端胃切除术(laparoscopic-assisted distal gastrectomy,LADG)治疗胃癌疗效的对比研究文献,利用RevMan 5.3软件进行Meta分析。结果共纳入18篇文献,共计3 389例胃癌患者,其中LADG组1 860例,TLDG组1 529例,均为亚洲人群。Meta分析结果显示,与LADG组相比,TLDG在手术时间、近、远端切缘距离、术后排气、进食时间、术后使用止痛药以及术后并发症上差异均无统计学意义(均P值>0.05),但是TLDG组的术中出血量较LADG组明显减少(OR=33.63,95%CI为15.87~51.39),淋巴结清除数目更多(OR=-1.96,95%CI为-3.67^-0.26),且住院时间更短(OR=0.60,95%CI为0.02~1.17)。结论 TLDG在亚洲人群中,治疗胃癌是安全有效的,具有良好的近期疗效。而对于欧美人群,TLDG是否同样具有较好的近期疗效,仍值得进一步研究证实。OBJECTIVE In recent years, there are increasing reports in the treatment of gastric cancer with totally laparoscopic distal gastrectomy （TLDG）, and its surgical curative effect also becomes a major concern. In this paper, we evaluated the short-term clinical outcomes of TLDG in the treatment of gastric carcinoma. METHODS The literatures comparing TLDG with LADG published up to November 2015 in several databases were retrieved and analyzed systematically. After screening for inclusion, data extraction and quality assessment, Meta-analysis was conducted by the Review Manager 5.3 software. RESULTS Totally eighteen studies were finally included. The total sample size of the studies was 3 389 cases. Among them, 1 860 cases underwent LADG and 1 529 cases were subjected to TLDG, they were all A- sian people. Meta-analysis results showed that there were no significant statistical differences between LADG group and TLDG group in the following aspects： operative time, the resection margin length, the first aerofluxus time and the eating time, analgesics use and overall postoperative complications（all P〉0. 05）. But when compared to LADG, estimated blood loss was significantly less in TLDG （OR= 33.63,95%CI= 15.87,51.39） and TLDG also had more retrieved lymph nodes （OR=-1.96,95%CI=-3.67,-0.26） and lesser postoperative hospital stay（OR=0.60,95%0CI=0.02,1.17）. CONCLUSIONS TLDG is safe and feasible in treatment of gastric cancer, and has a good short-term effect for Asians. For the European and American people, whether TLDG also has good curative effect still deserves further study.

关 键 词：胃癌 腹腔镜胃切除术 腔内吻合 META分析 

分 类 号：R735.2[医药卫生—肿瘤]