腹腔镜对比传统开腹手术对于早期远端胃癌的手术疗效的Meta分析

Meta-analysis of the efficacy of laparoscopic surgery compared to traditional open surgery for early distal gastric cancer

目的本研究对比分析和评价早期远端胃癌患者行腹腔镜大部切除与传统开腹手术治疗的临床疗效与安全性。方法从Pub-med、EMBASE、中国生物医学数据库(CBM)、以及Cochrane实验注册中心检索2002年7月—2012年7月发表的有关对比腹腔镜手术和开腹手术治疗早期远端胃癌患者的关于近期疗效的文献,由2位胃肠外科医生独立地对入选研究的实验对象特征及实验设计和研究结果等内容进行摘录,并用RevMan 5.0软件进行系统分析。结果经过筛选有7个随机对照试验(ran-domized controlled trials,RCT)共计382例早期胃癌患者纳入系统评价。Meta分析结果指出:与传统开腹手术相比,腹腔镜组术后肠道恢复排气时间短[WMD:-0.70,95%CI:(-81.00,-58.00),P<0.001],术后使用镇痛药物次数较少[WMD:-4.77,95%CI:(-6.77,-2.77),P<0.000 1],住院时间短[WMD:-1.54,95%CI:(-2.02,-1.06),P<0.001],术中清扫淋巴结数目比较开腹手术略少[WMD:-4.19,95%CI:(-6.08,2.29),P<0.001],术后并发症腹腔镜组与开腹组之间较低[OR:0.57,95%CI:(0.31,1.03)]。结论腹腔镜早期远端胃手术比较传统开腹手术,在术后有效性及安全性上具有明显优势。

Objective To comparatively analyze and evaluate clinical efficacy and safety of early distal gastric cancer patients undergoing laparoscopic surgery or traditional open surgery.Methods Electronic databases（such as PubMed,the Cochrane Central Register of Controlled Trials,CBM,VIP,CNKI and wanfang） were searched to form data from,July 2002 to July 2012 about the effect of laparoscopic surgery or open surgery on patients with early distal gastric cancer.Conference proceedings and clinical trails website（http： / / clinicaltrials.gov /） also had been scanned.Efficacy literatures were recorded independently by two gastrointestinal surgeons enrolled in the study of experimental design,and then the RevMan5.0 software was used for meta analysis.Results After screening a total of 382 cases of patients with early gastric cancer seven randomized controlled trials（randomized controlled trials,RCT） were included in the systematic reviews.The results of meta analysis showed that compared with open surgery group,postoperative use of analgesic drugs was less frequently in laparoscopic surgery group[WMD：-4.77,95% CI：（-6.77,-2.77）,P 0.000 1],with shorter hospital stay[WMD：-1.54,95% CI：（-2.02,-1.06）,P 0.001],the number of harvested lymph node slightly less[WMD：-4.19,95% CI：（-6.08,2.29）,P 0.001],with fewer postoperative complications[OR： 0.57,95% CI：（0.31,1.03） ].Conclusion Laparoscopic surgery has obvious advantages in postoperative efficacy and safety over traditional open surgery.