胃癌根治术中完整网膜囊切除对术后局部复发率及生存率影响的Meta分析

Effect of Bursectomy on Local Recurrence and Survival Rate after Radical Gastrectomy:A Meta Analysis

目的探讨胃癌根治术中完整网膜囊切除对术后局部复发及生存率的影响。方法检索Pubmed(1966年1月至2012年10月)、Embase(1974年1月至2012年10月)、中国知网(1994年1月至2012年10月)等数据库并交叉核对文献,初筛纳入英文文献359篇、中文文献101篇。再依纳入标准"胃癌行D1-D2根治术、对术中行网膜囊完整切除与不完整切除进行分组、术后3年行局部复发率及总生存率的统计"筛选,共入选6篇文献。采用RevMan 5.2软件进行Meta分析。结果纳入6篇文献,共1 869例D1-D2胃癌根治术患者的临床资料。其中完整网膜囊切除组1 370例,非完整网膜囊切除组499例,两组局部复发率差异无统计学意义[OR=0.92,95%CI(0.62,1.37)],3年总生存率间差异无统计学意义[OR=0.78,95%CI(0.53,1.16)]。其中进展期胃癌,完整网膜囊切除组237例,非完整网膜囊切除组225例,两组间局部复发率差异无统计学意义[OR=0.84,95%CI(0.54,1.31)],3年总生存率差异无统计学意义[OR=0.76,95%CI(0.48,1.20)]。结论 D1-D2胃癌根治术中进行完整网膜囊切除对降低局部复发率和提高患者生存率方面没有明显优势。

Objective To investigate the effect of bursectomy on local recurrence and survival rate after radical gastrectomy.Methods Pubmed（from January 1966to October 2012）,Embase（from January 1974to October 2012）and CNKI（from January 1994 to October 2012）were searched for eligible studies.A total of 359articles published in English and 101in Chinese were initially achieved.Six studies were eventually involved.The inclusion criteria consisted of D1-D2 radical gastrectomy, grouping in terms of bursectomy or not,and statistical analysis of the local recurrence and survival rate 3years after operation.The Meta analysis was performed by using RevMan 5.2 software package.Results The six studies involved a total 1 869 gastric cancer patients after radical gastrectomy and D1-D2lymphadenectomy.There were 1 370 patients in bursectomy group and 499patients in non-bursectomy group.There was no significant statistical difference in 3-year postoperative local recurrence between bursectomy and non-bursectomy groups[OR=0.92,95%CI（0.62,1.37）].No statistical difference in survival rate 3 years after surgery was found between the two groups[OR=0.78,95%CI（0.53,1.16）].For advanced gastric cancer patients, there were 237in bursectomy group and 225in non-bursectomy group.Also,there was no significant difference in 3-year postoperative local recurrence[OR=0.84,95% CI（0.54,1.31）]and survival rate[OR=0.76,95%CI（0.48,1.20）]between the two groups.Conclusion Bursectomy can not reduce the local recurrence and increase the survival rate of gastric cancer patients after radical gastrectomy and D1-D2lymphadenectomy.