全腹腔镜全胃切除手术与腹腔镜辅助全胃切除手术比较治疗胃癌疗效和安全性的Meta分析  

Efficacy and safety of totally laparoscopic total gastrectomy versus laparoscopic assisted total gastrectomy for gastric carcinoma:a meta-analysis

作　　者：丁蔚 谭玉林[1] 薛文波[1] 王一波[1] 徐逸昕[1] 徐学忠[1] 

机构地区：[1]江苏大学附属武进医院普外科,江苏常州213002

出　　处：《中国循证医学杂志》2018年第1期21-28,共8页Chinese Journal of Evidence-based Medicine

基　　金：常州市武进区科技发展计划项目(编号:WS201515)

摘　　要：目的系统评价全腹腔镜全胃切除术(totally laparoscopic total gastrectomy,TLTG)与腹腔镜辅助全胃切除术(laparoscopic-assisted total gastrectomy,LATG)治疗胃癌的疗效和安全性。方法计算机检索PubMed、EMbase、The Cochrane Library、CBM、WanFang Data和CNKI,搜集TLTG与LATG治疗胃癌的队列研究,检索时限均从建库至2017年2月28日。由2位研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入6个队列研究,其中TLTG组407例,LATG组315例。Meta分析结果显示,与LATG组相比,TLTG组患者手术时间更短[MD=–8.97,95%CI(–16.21,–1.73),P=0.02],术后首次进食时间更早[MD=–0.30,95%CI(–0.57,–0.03),P=0.03]。但两组在吻合时间、出血量、淋巴结清扫数目、上切缘、首次通气时间、术后住院时间、术后总并发症、吻合口瘘及吻合口狭窄方面差异无统计学意义(P值均>0.05)。结论相对于LATG,TLTG具有手术时间短、术后恢复快的优势。但受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。Objective To systematically review the efficacy and safety of totally laparoscopic total gastrectomy （TLTG） versus laparoscopic-assisted total gastrectomy （LATG） for patients with gastric cancer. Methods Databases including PubMed, EMbase, The Cochrane Library, CBM, WanFang Data and CNKI were searched to collect cohort studies about TLTG vs. LATG for gastric cancer from inception to February 28th 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software. Results A total of six cohort studies were included, of which 407 cases were in the TLTG group, and 315 cases were in the LATG group. The results of meta-analysis showed that compared with LATG group, patients in TLTG group had shorter operation time （MD=-8.97, 95%CI -16.21 to -1.73, P=0.02）, and initial postoperative feeding time （MD=-0.30, 95%CI -0.57 to -0.03, P-0.03）. However, the anastomic time, bleeding volume, the number of dissected lymph nodes, proximal resection margin, initial flatus time, postoperative hospital stay, overall postoperative complications, anastomotic fistula, and anastomotic stenosis were similar between two groups （all P values〉0.05） Conclusions Compared with LATG, TLTG has shorter operation and recovery time for patients with gastric cancer. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.

关 键 词：腹腔镜 胃癌 胃切除 队列研究 META分析 

分 类 号：R735.2[医药卫生—肿瘤]