手助腹腔镜和腹腔镜辅助在胃癌D2根治术中临床疗效的Meta分析  

Clinical efficacy of hand-assisted laparoscopic versus laparoscope-assisted D2 radical gastrectomy for gastric cancer:A systematic review and meta-analysis

作　　者：吴昱朋 张海强[1] 王海军[1] 张全超 王吉喆 张占学[1] Wu Yupeng;Zhang Haiqiang;Wang Haijun;Zhang Quanchao;Wang Jizhe;Zhang Zhanxue(Department of Gastrointestinal Surgery,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院胃肠外科,石家庄050000

出　　处：《中国医师杂志》2020年第8期1157-1162,1167,共7页Journal of Chinese Physician

基　　金：河北省卫生健康委员会科研基金(20200042);河北省卫计委医学科学研究重点课题计划(ZD20140383)。

摘　　要：目的比较分析手助腹腔镜和腹腔镜辅助治疗进展期胃癌的临床疗效。方法检索2000年至2019年发表于PubMed、Cochrane library、EM-BASE、中国知网、万方、维普,中文科技期刊全文数据库、中国生物医学文献数据库上关于手助腹腔镜(HALS)和腹腔镜辅助(LAS)在胃癌D2根治术上疗效对比的文献,按预先制定的纳入及排除标准筛选文献,并进行质量评价,用RevMan 5.3软件对两组患者的手术近期指标及并发症进行Meta分析。结果最终纳入10篇文章,共1277例患者,其中HALS组629例,LAS组648例,Meta分析结果显示与LAS组相比,HALS组手术时间短(WMD=24.02,95%CI:-40.41^-7.62,P=0.004),但辅助切口稍长(WMD=0.27,95%CI:0.06~0.47,P=0.01),其余在淋巴结清扫个数(WMD=0.58,95%CI:-1.22~2.39,P=0.53)、术中出血量(WMD=-7.94,95%CI:-16.21~0.33,P=0.06)、胃肠道恢复时间(WMD=0.00,95%CI:-0.03~0.04,P=0.85)、住院总时间(WMD=-0.14,95%CI:-0.36~0.09,P=0.23)及术后并发症(OR=0.89,95%CI:0.58~1.37,P=0.61)上差异无统计学意义。结论对于进展期胃癌实行D2根治术,手助腹腔镜相比于腹腔镜辅助,手术时间显著缩短,易于开展,但切口长度稍有增加,临床医师可以根据术中具体情况结合自身选择合适术式。Objective To compare and analyze the clinical efficacy of hand-assisted laparoscopic surgery(HALS)and laparoscopic assisted surgery(LAS)in the treatment of advanced gastric cancer.Methods Articles of the efficacy comparison of HALS and LAS in D2 radical gastrectomy for gastric cancer from 2000 to 2019 published in PubMed,Cochrane library,EM-BASE,China National Knowledge Infrastructure(CNKI),Wanfang,Weipu,Chinese full-text database of Chinese Sci-Tech journals,Chinese biomedical literature database were retrieved,and the literatures were screened according to the pre-established inclusion and exclusion criteria.The quality of the two groups was evaluated,and the short-term indexes and complications for meta-analysis of the two groups were analyzed by using Revman 5.3 software.Results A total of 1277 patients were included in 10 articles,including 629 in the HALS group and 648 in the LAS group.The results of the meta-analysis showed that compared with the LAS group,the operation time was shorter in the HALS group(WMD=24.02,95%CI:-40.41--7.62,P=0.004),but the auxiliary incision was slightly longer(WMD=0.27,95%CI:0.06-0.47,P=0.01),and there were no statistically significant difference in the remaining number of lymph node dissections(WMD=0.58,95%CI:-1.22-2.39,P=0.53),intraoperative blood loss(WMD=-7.94,95%CI:-16.21-0.33,P=0.06),gastrointestinal tract recovery time(WMD=0.00,95%CI:-0.03-0.04,P=0.85),total length of hospital stay(WMD=-0.14,95%CI0:-0.36-0.09,P=0.23)and postoperative complications(OR=0.89,95%CI:0.58-1.37,P=0.61).Conclusions Compared with the LAS for D2 radical surgery of advanced gastric cancer,HALS has significantly shorter operation time and is easier to perform than LAS,but the incision length is slightly increased.Physicians can choose the appropriate operation method according to the specific conditions of the operation and themselves.

关 键 词：胃肿瘤 手助腹腔镜检查 腹腔镜辅助外科手术 

分 类 号：R735.2[医药卫生—肿瘤]