腹腔镜辅助下远端胃大部切除术治疗早期胃癌的系统评价

Systematic review of laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer

目的:评价腹腔镜辅助下远端胃大部切除术(laparoscopy-assisted distal gastrectomy,LADG)治疗早期胃癌的安全性及有效性。方法:本研究从MEDLINE、EMBASE、中国生物医学数据库(CBM)及Cochrane试验注册中心检索并纳入了在1991年-2007年3月间发表的LADG治疗早期胃癌的随机对照试验,并对纳入研究的方法学质量(随机、双盲和对照)进行评价,最后用Revman4.2.9软件进行分析。结果:共纳入4个随机对照试验(randomized controlled trials,RCT),包括123例患者。与开腹远端胃大部切除术(open distal gastrectomy,ODG)相比,LADG术后并发症少[OR(odd ratio)0.32,95%CI(confidenceinterval)(0.14,0.71)]、术中出血少[WMD(weight mean difference)-85.72,95%CI(-166.87,-4.58)]、止痛剂的使用次数少[WMD-1.69,95%CI(-2.18,-1.21)]、术后第1次排气时间早[WMD-0.68,95%CI(-1.26,-0.09)];住院时间、切口或吻合口并发症、复发率、转移、死亡率和生存率无明显差异。淋巴结清扫数少于或与ODG相当。但是,LADG手术时间长于ODG。结论:LADG治疗早期胃癌的近期效果优于ODG,远期效果和ODG相当。

Objective：To evaluate the safety and effectiveness of laparoscopy-assisted distal gastrectomy （LADG） in treating early gastric cancer. Methods： We searched randomized controlled trials （RCTs） published in MEDLINE, EMBASE, the Chinese Biomedical Database （ CBM ） and Cochrane Central Register from 1991 to March 2007 and included RCTs compared LADG to ODG for early gastric cancer. We also evaluated the methodological quality of included studies that involved randomization, blinding, contral. Metaanalysis was performed using Revman 4.2.9 software. Results：Four RCT involving 123 patients were included. Compared to open distal gastrectomy （ ODG ） , LADG had less complications [ odd ratio （ OR ） 0. 33, 95 % confidence interval （CI） （ 0.14 to 0.77 ） ] , less estimated blood loss [ weight mean difference（WMD） - 85.72, 95% CI （ - 166.87 to - 4.58 ） ], lower frequency of analgesic requirement [WMD -1.69, 95% CI（ -2.18 to -1.21）], more early postoperative first flatus [WMD -0.68, 95%CI （ -1.26 to -0.09）]. There was no significant difference between two groups in duration of hospital stay, wound or anastomotic complications, recurrence rate, metastasis rate, death rate and survival rate. The mean number of harvested lymph nodes was less or equal to ODG. But the operation time was significantly longer in LADG. Conclusion： In this systematic review, the short-term outcome of LADG for early gastric cancer is superior to ODG, and the long-term outcome is similar with ODG.