腹腔镜手术对早期远端胃癌短期疗效的meta分析

Meta-analysis of short-term efficacy of laparoscopic-assisted distal gastrectomy for early gastric cancer

目的:通过meta分析评估早期远端胃癌根治术中腹腔镜手术的短期临床疗效与安全性。方法:从Pub Med、Cochrane library等数据库中搜索2014年4月以前发表的研究对象为腹腔镜辅助远端胃大部切除术(laparoscopy-assisted distal gastrectomy,LADG)、开腹远端胃癌根治术(open distal gastrectomy,ODG)治疗早期远端胃癌患者近期疗效的随机对照试验(randomized controlled trials,RCT)文献,采用Rev Man 5.2软件对纳入的数据进行meta分析。结果:共7篇RCT纳入本研究。纳入病例数为692例,其中LADG组354例,ODG组338例,meta分析结果提示:两组患者进食时间[加权均数差(WMD)=-0.49,95%CI(-1.45,0.47)]与术后住院时间[WMD=-1.44,95%CI(-3.17,0.29)]差异无统计学意义,LADG组手术时间较长[WMD=82.91,95%CI(58.59,107.24)],淋巴结清扫数量略少[WMD=-4.62,95%CI(-6.58,-2.66)];但术中出血量[WMD=-103.58,95%CI(-140.75,-66.42)]更少,术后排气时间[WMD=-0.55,95%CI(-1.02,-0.08)]更短,术后早期并发症发生率[比值比(OR)=0.44,95%CI(0.27,0.70)]更低。结论:腹腔镜早期远端胃癌根治术后患者肠道功能恢复较快,并发症较少,短期效果优于开腹手术。

Objective：To evaluate the short-term efficacy and safety of laparoscopic-assisted distal gastrectomy （LADG） for early gastric cancer by meta analysis. Methods ： Electronic databases （ such as PubMed, the Cochrane Central Register of Controlled Tri- als） were searched for randomized controlled trials （RCT） before Apr. 2014 about the effect of LADG or open distal gastrectomy （ODC） on patients with early distal gastric cancer, and then the RevMan 5.2 software was used for meta analysis. Results：A total of seven RCTs were included in the study ,692 cases contained 354 patients with the LADG and 338 patients with the ODG. The results of meta analysis showed that feeding time [ weighted mean difference （WMD） = 4）. 49,95% CI（-1. 45,0.47） ] and postoperative hospital stay [WMD =-1.44,95% CI（-3. 17,0.29）] were not statistically different between the two groups. And compared with the ODG group,except a longer surgery time [ WMD = 82.91,95% CI（58.59,107.24） ] and fewer number of harvested lymph node [ WMD = - 4.62,95% CI（-6.58 ,-2.66 ）], the LADG group had less bleeding during the operation [ WMD =-103.58,95% CI （-140.75 ,-66. 42） ] ,a shorter time for postoperative passage of gas by anus [WMD = 4）. 55,95% CI（-1.02,4）. 08） ] ,and fewer postoperative early complications [ odds ratio （OR） = 0.44,95 % CI （ 0.27,0.70 ） ]. Conclusions ： Patients with LADG for early gastric cancer have a faster recovery of bowel function and fewer complications over ODG, and have a better short-term efficacy.