腹腔镜与开腹D_2远端胃切除术治疗胃癌的Meta分析

Laparoscopy-assisted versus open distal gastrectomy with D_2 lymphadenectomy for gastric cancer: a Meta-analysis

目的:评价腹腔镜辅助D2远端胃切除术治疗胃癌的价值。方法:收集1995—2010年公开发表的实施D2淋巴清扫的腹腔镜辅助远端胃切除术和开腹远端胃切除术治疗胃癌的中文和英文文献,对两种术式的手术时间、出血量、清扫淋巴结数目、排气及进食时间、住院时间、并发症发生率、病死率和复发率共9个效应量进行Meta分析。结果:筛选出符合纳入标准的8项研究(1 065例)。与开腹组比较,腹腔镜辅助组的出血量和并发症减少,胃肠功能恢复时间、进食时间和住院时间缩短,但手术时间延长(均P<0.05)。两组清扫淋巴结数目、病死率和复发率的差异无统计学意义(均P>0.05)。结论:腹腔镜辅助远端胃D2根治术具有侵袭性小、并发症少、恢复快的优点,能够获得与开腹手术相当的根治效果和短期疗效。

Objective： To assess the value oflaparoscopy-assisted distal gastrectomy （LADG） with D2 lymphadenectomy for gastric cancer. Methods： Publicly published studies in both Chinese and English concerning laparoscopy-assisted D2 gastrectomy versus open D2 gastrectomy were collected, and then, data that included operative time, blood loss, number of dissected lymph nodes, time to first flatus and food intake, length of hospital stay3 incidence of complications, mortality and recurrence between two groups of patients undergoing laparoscopy-assisted D2 gastrectomy and open D2 gastrectomy were compared by Meta-analysis.Results： Eight studies （1 065 patients） meeting inclusion criteria were finally selected. Compared with open surgery group, the intraoperative blood loss and incidence of complications were reduced, time to first flatus and food intake, and length of hospital stay were shortened, but operative time was prolonged （all P〈0.05）. There were no significant differences in the number of dissected lymph nodes, mortality, and recurrence rate between the two groups （all P〉0.05）. Conclusion： Laparoscopy-assisted D2 gastrectomy has the advantages of minimal invasion, faster recovery and fewer complications, and can achieve the same results and short-term efficacy as open radical operation.