腹腔镜辅助保留幽门胃切除术治疗早期胃癌围手术期结局的荟萃分析  

Meta-analysis of perioperative outcomes of laparoscopic-assisted pyloric sparing gastrectomy for early gastric cancer

作　　者：杨钧淞 赖剑雄 赵庆云 谭淼 何劲松[1] 唐果 魏寿江[1] Yang Junsong;Lai Jianxiong;Zhao Qinyun;Tan Miao;He Jinsong;Tang Guo;Wei Shoujiang(First Department of Gastroenterology,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China)

机构地区：[1]川北医学院附属医院胃肠外一科,南充637000

出　　处：《国际外科学杂志》2021年第11期742-748,F0003,共8页International Journal of Surgery

基　　金：国家卫生健康委医药卫生科技发展研究中心资助项目(WA2020RW05)。

摘　　要：目的通过荟萃分析的方法来探讨腹腔镜辅助保留幽门胃切除术(LPPG)和腹腔镜辅助远端胃大部切除术(LDG)治疗早期胃癌的有效性和安全性。方法检索Web of Science、Cochrane library、Embase、中国生物医学文献数据库、中国知网、万方中文数据库, 以鉴定所有比较LPPG与LDG在早期胃癌中的合格研究, 检索时间从建库截至2020年10月。应用比值比对二分类变量进行评价, 正态分布的计量资料以均数±标准差(Mean±SD)表示, 并计算最终结果的95%CI。使用RevMan软件对围手术期结局进行分析。结果共纳入10项研究, 累计1613例患者, 其中LPPG组624例, LDG组989例。荟萃分析结果表明:两组在手术时间、术中失血量、术后肛门排气时间、住院时间、总体并发症发生率方面的差异无统计学意义(P>0.05)。与LDG组相比, LPPG组的淋巴结清扫数目更少(MD=-2.51, 95%CI:-4.31~-0.71, P=0.006), 术后留置胃管时间更长(MD=1.05, 95%CI:0.31~1.80, P=0.006), 胃排空延迟的发病率更高(P<0.01), 而在其他围手术期并发症方面两组间差异无统计学意义。结论 LPPG是治疗早期胃癌的一种安全可行的手术方式, 可作为LDG的一种替代方案。Objective:To conduct a Meta-analysis of the efficacy and safety of laparoscopy-assisted pylorus-preserving gastrectomy(LPPG)and laparoscopy-assisted distal gastrectomy(LDG)in early gastric cancer(EGC).Methods:Searched Web of Science,Cochrane library,Embase,Chinese Biomedical Medical Database,CNKI,Wanfang Database to identify all qualified studies comparing LPPG and LDG in EGC.The retrieval time was from the database establishment to October 2020.Measurement data with normal distribution were represented as(Mean±SD).Comparing two groups by mean difference(MD)with 95%confidence interval(CI)for contious outcomes and odds ratio(OR)with 95%CI for dichotomous data.The RevMan software was used to analyze the perioperative outcome.Results:A total of 10 studies were included,with a total of 1613 patients,624 in the LPPG group and 989 in the LDG group.Operation time,intraoperative blood loss,postoperative anal exhaust time,hospital stay,and overall complication rate of LPPG were similar to LDG.Compared with the LDG group,the LPPG group had fewer lymph node dissections(MD=-2.51,95%CI:-4.31~-0.71,P=0.006),longer postoperative gastric tube indwelling time(MD=1.05,95%CI:0.31~1.80,P=0.006),and a higher incidence of delayed gastric emptying(P<0.01).There was no statistically significant difference between the two groups in terms of other perioperative complications.Conclusion:LPPG is a safe and feasible surgical method for the treatment of EGC,and can be used as an alternative to LDG.

关 键 词：腹腔镜 胃肿瘤 胃切除术 META分析 

分 类 号：R735.2[医药卫生—肿瘤]