腹腔镜辅助远端胃切除术治疗进展期胃癌疗效和安全性的Meta分析

Efficacy and Safety of Laparoscopy-assisted Distal Gastrectomy in Advanced Gastric Cancer: A Meta-analysis

目的系统评价腹腔镜辅助远端胃切除术治疗进展期胃癌的疗效及安全性。方法计算机检索Medline Ovid(2000-2013)、Pub Med(2000-2012)、Cochrane Review(2000-2012)等外文期刊以及CNKI(2000-2013)、CMB(2000-2012)、VIP(2000-2013)等中文期刊,收集腹腔镜辅助与开腹远端胃切除术治疗进展期胃癌的随机对照试验或病例对照试验。采用Cochrane协作网专用软件Rev Man 5.0.22对数据进行统计分析。结果共纳入8个病例对照研究(7篇英文文献,1篇中文文献),合计1373例患者。Meta分析结果显示:虽然腹腔镜远端胃切除术与开腹手术相比,手术时间显著延长[MD=41.41,95%CI(23.48,59.34),P<0.00001]。但是腹腔镜组具有出血量少[MD=-132.08,95%CI(-177.54,-86.62),P<0.00001],术后止疼药物使用剂量少[MD=-1.62,95%CI(-2.51,1.73),P=0.0004],住院时间短[MD=-3,95%CI(-3.41,-2.6),P<0.00001]等优点。两组患者在淋巴结清扫的数量[MD=0.28,95%CI(-0.99,1.54),P=0.66]、术后并发症发生率[OR=1.27,95%CI(0.85,1.91),P=0.25]、围手术期死亡率[OR=0.65,95%CI(0.26,1.63),P=0.36]、肿瘤复发率[OR=0.87,95%CI(0.67,1.13),P=0.28]以及三年总体生存率[OR=1.21,95%CI(0.92,1.60),P=0.18]方面没有统计学意义。结论腹腔镜辅助远端胃切除术对治疗进展期胃癌安全可行,并可获得与开腹手术相当的临床效果,虽然传统开腹手术能够缩短手术时间,但腹腔镜远端胃癌根治术患者可能从更短的住院时间和更快的术后恢复中受益。

Objective To systematically review the efficacy and safety of laparoscopy-assisted distal gastrectomy in advanced gastric cancer. Methods A search of Medline Ovid（ 2000-2013）,Pub Med（ 2000-2012） and Cochrane Review（ 2000-2012） for foreign languages journal and CNKI（ 2000-2013）,CBM（ 2000-2012）,VIP（ 2000-2013） for Chinese journal identified all randomized controlled trials compared laparoscopy-assisted gastrectomy with open distal gastrectomy in patients with advanced gastric cancer. And statistic analysis was performed using Rev Man 5. 0. 22. Results 8 case-control studies involving 1373 patients were included. The analysis showed that laparoscopy-assisted distal gastrectomy significantly extended the operation time when compared with open distal gastrectomy. But the patients underwent laparoscopy-assisted gastrectomy had smaller amount of bleeding,less analgesic using and shorter hospital stays. The amount of lymph node dissection,incidence rate of postoperative complications,perioperative mortality,recurrence rate of gastric cancer and 3-year overall survival did not demonstrate statistic significance.Conclusion Laparoscopy distal gastrectomy was safe and effective for patients with advanced gastric cancer,having comparable efficacy when compared with open distal gastrectomy. Though extended operation time,patients underwent laparoscopy gastrictemy were likely to benefit from shorter hospital stays and earlier postoperative recovery.