内镜下黏膜切除术与内镜黏膜下剥离术对早期胃癌疗效的Meta分析

Endoscopic submucosal dissection versus endoscopic mucosal resection for early gastric cancer: a Meta-analysis

目的:系统评价内镜下黏膜切除术(EMR)与内镜黏膜下剥离术(ESD)治疗早期胃癌(EGC)的疗效及安全性。方法:检索多个国内外数据库,收集相关临床研究文献,筛选出符合纳入标准的合格文献后行Meta分析。结果:最终纳入15个临床病例对照研究,共4 673例患者,其中ESD组2 154例,EMR组2 519例。Meta分析显示,ESD组的手术时间长于EMR组,但整块切除率、完整切除率、治愈切除率均高于EMR组(均P<0.05);并发症方面,两组出血的发生率差异无统计学意义(P>0.05),但ESD组的穿孔发生率高于EMR组(P<0.05);ESD组术后局部复发率低于EMR组(P<0.05)。结论:ESD治疗EGC切除率高、局部复发率低,但手术时间长、穿孔率高,但以上结论还需要大样本、高质量的研究进一步证实。

Objective： To systematically evaluate the efficacy and safety of endoscopic submucosal dissection （ESD） versus endoscopic mucosal resection （EMR） for early gastric cancer （EGC）. Methods： The related literature of clinical studies was selected by searching several national and international databases, and the eligible studies that met the inclusion criteria were screened out and then assessed by Meta-analysis. Results： Fifteen case-control studies were finally induded involving 4 673 patients, with 2 154 cases in ESD group and 2 519 cases in EMR group. Meta-analysis showed that the operative time was prolonged, but the en bloc resection rate, complete resection rate and curative resection rate were all increased in ESD group compared with EMR group （all P〈0.05）; as for the complications, the incidence of bleeding of the two groups had no statistical difference （P〉O.05）, but the incidence of gastric perforation was higher in ESD group than that in EMR group （P〈0.05）;the postoperative local recurrence rate in ESD group was lower than that in DMR group （P〈0.05）. Conclusion： For EGC, ESD offers high resection rate and low local recurrence rate, but has prolonged operative time and increased incidence of gastric perfusion. However, above conclusion needs further verification by high- quality clinical studies with larger sample size.