进展期胃癌合并胆石类疾病患者行胃癌联合胆囊切除与单纯胃癌根治两种手术类型安全性的Meta分析

Meta analysis about safety of gastrectomy combined with cholecystectomy and radical gastrectomy for patients with progressive gastric cancer combined with gallstone

目的系统评价进展期胃癌合并胆石类疾病患者行胃癌联合胆囊切除与单纯胃癌根治两种手术类型的安全性并进行评估。方法以胆囊结石、胃癌根治术、胆囊切除术、胃癌联合胆囊切除术、Prophylactic cholecystectomy、Gastric cancer、Gastrectomy Gallbladder stones、The same period surgical、Randomized trial等为关键词检索Cochrance Library、Pub Med、中国期刊全文数据库、中国生物医学文献数据库、中文科技期刊全文数据库和万方数据库。检索日期为各数据库建库至2014年12月。最终纳入胃癌联合胆囊切除与单纯胃癌根治两种手术类型安全性对比的相关文献,由2名研究者独立提取数据并进行文献质量评价,用Reviman 5.1.2软件进行Meta分析。计数资料采用相对危险度（Risk ratio,RR）或比值比（Odds ratio,OR）分析统计,计量资料则采用均数差（mean Difference,MD）或者标准差（standard mean difference,SMD）分析统计。采用I2对异质性进行定量分析。结果共纳入符合标准的文献8篇,其中胃癌联合胆囊切除组446例,单纯胃癌根治组1124例,Meta分析结果显示：与单纯胃癌根治的术后并发症发生率、术后3天引流量、术后死亡率相比差异无统计学意义（OR=1.16,1.63,MD=-19.90,95%CI：0.82～1.63,-102.60～62.80,0.54～4.91,P〉0.05）。术中出血量及手术时间比较,差异有统计学意义（MD=46.6%,0.29%,95%95%CI：27.69～65.50,0.19～0.39,P〈0.05）。结论进展期胃癌合并胆石类疾病患者行胃癌联合胆囊结石切除是安全可靠的。

Objective To evaluate their safety about two kinds of operation ways（radical gastrectomy combined with cholecystectomy and radical gastrectomy） to treat patients undergoing progressive gastric cancer and gallstone.Methods The cochrance library,pubmed,China Journal full text Database,Chinese Scientific Journal Full text database,Chinese biomedical literature database and Wanfang database were searched using key words such as prophylactic cholecystectomy,gastric cancer,gastrectomy gallbladder stones,the same period surgical,randomized trial and so on.Searching time was from the time when all database established to December 2014.Literatures focused on safety of radical gastrectomy combined with simultaneous cholecystectomy or radical gastrectomy to cure patients with advanced gastric cancer and gallstone.Data analysis was done by 2 researchers independently.Meta analysis was performed by Revi Man 5.1.2software.The count data were analysed by risk ratio（RR）or odd ratio（OR）,and the measurement data were analysed by mean difference（MD） or standard mean difference（SMD）.The heterogeneity of the literatures was analyzed using the I2.Results Eight literatures were included,in which 446 patients was treated with gastrectomy combined with gallbladder surgery and 1124 patients were given only gastrectomy.The result of Meta analysis showed between proceeding radical gastrectomy combined with simultaneous cholecystectomy and radical gastrectomy to cure patients with advanced gastric cancer and gallstone,there were significant differences in the operation time,amount of bleeding.But there were no significant differences in postoperative complications,volume of postoperative drainage after three days,death rate between two groups.Conclusion Radical gastrectomy combined with simultaneous cholecystectomy for patients with gastric cancer and gallstone is safe and feasible.