全胃切除术与近端胃切除术治疗近端胃癌的Meta分析

Meta analysis of total versus proximal gastrectomy for proximal gastric cancer

目的:评价全胃切除(total gastrectomy,TG)术与近端胃切除(proximal gastrectomy,PG)术治疗近端胃癌的价值。方法:收集TG与PG治疗近端胃癌的文献,评估2组的术中淋巴结清扫数、术中出血量、手术时间、术后并发症、病死率、5年生存率、复发率及营养状况,使用RevMan 5.0进行Meta分析。结果:入选文献25篇,其中随机对照研究3篇。PG组和TG组总并发症发生率(OR=1.93,95%CI=0.97~3.85,P=0.060)、吻合口漏(OR=0.74,95%CI=0.31~1.76,P=0.490)、肠梗阻(OR=0.45,95%CI=0.13~1.50,P=0.190)、反流性食管炎(OR=4.82,95%CI=0.94~24.62,P=0.060)、复发率(OR=2.45,95%CI=0.96~6.25,P=0.060)、5年生存率(OR=1.03,95%CI=0.55~1.93,P=0.930)、病死率(OR=1.35,95%CI=0.73~2.50,P=0.340)的差异无统计学意义,术中清扫淋巴结的数量(WMD=-11.14,95%CI=-17.81^-4.48,P=0.001)、术中出血量(WMD=-425.60,95%CI=-559.75^-291.46,P=0.000)、手术时间(WMD=-37.24,95%CI=-62.76^-11.72,P=0.004)、吻合口狭窄(OR=2.65,95%CI=1.11~6.33,P=0.030)的差异有统计学意义,TG组的术中清扫淋巴结数量、吻合口狭窄优于PG组,PG组在术中出血量、手术时间优于TG组。结论:TG术治疗近端胃癌有更好的远期效果。

Objective：To assess the value of proximal gastrectomy（PG） and total gastrectomy（TG） in the treatment of proximal gastric cancer. Methods：Studies comparing TG to PG for proximal gastric cancer were collected. Outcome measures included harvested LNs, blood loss,operation time,postoperative complication,mortality, 5-year overall survival rate,recurrence rate as well as nutritional states. Meta analysis was performed by RevMan 5.0. Results：Twenty five researches were included in these studies. Three of which were randomly controlled studies. There was no significant differences in postoperative complication（OR=1.93,95%CI=0.97 to 3.85, P=0.060）, anastomotic leak（OR=0.74,95%CI=0.31 to 1.76, P=0.490）, intestinal obstruction（OR=0.45,95%CI=0.13 to 1.50,P=-0.190）, reflux esophagitis （ 0R=4.82,95 %C1=0.94 to 24.62,P=0.060）, recurrence rate （ OR =2.45,95 %CI=0.96 to 6.25, P=0.060）, 5-year over- all survival rate（OR=1.03,95%CI=0.55 to 1.93,P=0.930）,mortality（OR=1.35,95%Cl=0.73 to 2.50,P=0.340）. While there were significant differences in the harvested LNs （ WMD=-11.14,95%CI=-17.81 to-4.48, P=0.001 ）, blood loss （ WMD=-425.60,95 % CI= -559.75 to -291.46, P=0.000）, operation time（ WMD=-37.2d, 95%CI=-62.76 to -11.72, P=0.00d）, anastomotic stenosis （O17=2.65, 95%CI=1.11 to 6.33,P=0.030）. Harvested LNs and anastomotic stenosis in TG group were better than those in PG group ;blood loss and operation time in PG group were better than those in TG group. Conclusion：TG has better long-term therapetic effect, in the treatment of proximal gastric cancer.