腹腔镜与开腹手术治疗进展期胃癌疗效的Meta分析

Comparison of the efficacy between laparoscopic and open gastrectomy for the treatment of advanced gas- tric cancer： a Meta analysis

目的系统评价腹腔镜与开腹手术治疗进展期胃癌的疗效。方法检索PubMed、EMBASE、The Cochrane Library和中国期刊全文数据库（CNKI）及中国生物医学期刊文献数据库（CMCC）收录2003年7月至2013年7月发表的有关腹腔镜手术与开腹手术治疗进展期胃癌疗效比较的文献。评估文献质量并提取数据资料，应用Review Manager5．0软件对其进行Meta分析。采用I^2对异质性进行定量分析。采用固定或随机效应模型合并数据。计数资料采用优势比（OR）及95％可信区间（95％CI）表示。结果共纳入文献12篇，其中1篇中文文献，11篇英文文献；1篇随机对照研究，11篇回顾性非随机对照研究。全体研究样本量合计2079例进展期胃癌，其中腹腔镜组882例，开腹组1197例。Meta分析结果显示：腹腔镜组与开腹组的手术时间、术中出血量、术后肛门排气时间、术后经口进食时间、术后住院时间比较，差异有统计学意义（WMD=41．33，-106．00，-0．55，-0．76，-2．62，95％CI：25．44-57．21，-120．71—-91．29，-0．80—-0．29，-1．29—-0．23，-4．05—-1．18，P〈0．05）；淋巴结清扫数目及术后并发症发生率比较，差异无统计学意义（WMD=0．22，OR=0．82，95％CI：-1．48～1．93，0．62～1．08，P〉0．05）。结论腹腔镜手术可以运用于进展期胃癌的根治性治疗，与开腹手术比较，在近期疗效上可以获益。

Objective To compare the perioperative efficacy between laparoscopic and open gastreetomy for the treatment of advanced gastric cancer. Methods Literatures on the comparison of the efficacy between laparoscopic and open gastrectomy were searched in the PubMed, EMBASE, the Cochrane Library, CNKI and CMCC. Articles were selected according to the inclusion criteria, and data were extracted from these trials by 2 reviewers independently and analyzed by Review Manager 5.0 software. The heterogeneity of the literatures was analyzed using the 12 test. Data were integrated by fixed or random effect model. The count data were presented by odds ratio （OR） and 95% confidence interval （95% CI）. Results Twelve literatures were retrieved, including 1 published in Chinese and 11 in English, 1 randomized controlled study and 11 retrospective non-randomized con- trolled studies. A total of 2 079 cases of advanced gastric cancer were included in this study, including 882 in the laparoscopic gastrectomy group and 1 197 in the open gastrectomy group. There were significant differences in the operation time, intraoperative blood loss, time to first flatus, time to first diet and duration of hospital stay between the 2 groups （ WMD = 41.33, - 106. 00, - 0. 55, - 0. 76, - 2.62, 95% CI： 25.44-57.21, - 120. 71- - 91.29, - 0. 80- - 0. 29, - 1.29- - 0. 23, - 4. 05- - 1.18, P 〈 0.05 ）. There were no significant difference in the number of lymph nodes harvested and incidence of complications between the 2 groups （ WMD = 0. 22, OR = 0. 82, 95% CI： - 1.48-1. 93, 0. 62-1. 08, P 〉 0.05 ）. Conclusion Laparoscopic gastreetomy can be safely performed for the treatment of advanced gastric cancer, and it brings benefits to patients in perioperative period than open gastrectomy.