内镜下切除和外科手术治疗早期胃癌的Meta分析

A meta analysis on endoscopic or surgical resection for treating early gastric cancer

目的比较内镜下切除和外科手术治疗早期胃癌的临床疗效及安全性。方法检索2000—2016年PubMed、Embase、Web of Science、The Cochrane Library内镜下切除和外科手术治疗早期胃癌的相关文献,利用STATA 12.0软件,对检出文献进行统计分析。结果共检索到20篇文献,患者6202例,均为回顾性队列研究。其中,内镜下切除3829例（内镜组）,传统手术2373例（手术组）。内镜组并发症发生率低于手术组[RR=0.48,95%CI（0.37~0.63）],内镜组住院时间少于手术组[标准均数差-2.60,95%CI（-3.53^-1.66）],内镜组局部复发率较手术组高[RR=4.93,95%CI（2.51~9.70）],内镜组异时肿瘤发病率较手术组高[RR=7.33,95%CI（4.12~13.05）],但两者5年生存率差异无统计学意义[RR=1.01,95%CI（0.99~1.03）]。结论内镜下切除治疗早期胃癌较传统手术创伤小、患者恢复快,但局部复发率及异时肿瘤发病率相对较高,需要严格掌握早期胃癌内镜下切除治疗指征,并加强随访。

Objective To compare the efficacy and safety of endoscopic resection and conventional surgery in the treatment of early gastric cancer. Methods The literatures from 2000 to 2016 including endoscopic resection（group ER） and conventional surgery（group CS） for early gastric cancer were retrieved from PubMed, Embase, Web of Science, the Cochrane Library, which were analyzed by STATA 12. 0 software for meta analysis. Results A total of 20 papers including 6202 patients was all retrospective cohort studies. The rate of complication and hospital stay were lower and shorter in group ER compared with those in group CS[RR =0.48, 95% CI （0. 37-0. 63） and standardized mean difference -2. 60, 95% CI （-3.53-- 1.66）], the rates of local recurrence and metachronous lesions were higher in group ER[RR=4. 93,95 %CI （2.51-9.70） and RR= 7.33,95 % CI（4. 12-13.05）], but the 5-year overall survival rate was not significantly different between two groups[RR= 1.01,95 %CI （0. 99-1.03）]. Conclusion Compared with conventional surgery, treating early gastric caneer by endoscopic resection has the advantages of small trauma and rapid recovery, but is with higher rates of local recurrence and metachronous lesions. In the treatment of early gastric cancer, strictly selecting indications for endoscopic resection and enhancing follow-up after endoscopic resection are needed.