腹腔镜与开腹手术治疗胃肠间质瘤的近期疗效对比Meta分析

Laparoscopic versus Open Surgery for Gastrointestinal Stromal Tumors:A Meta-Analysis of Short-Term Results

目的从循证医学角度系统评价腹腔镜切除术(LAP)治疗胃肠间质瘤的安全性、有效性和近期疗效。方法检索收集2005年7月到2015年7月发表的对比腹腔镜手术(LAP)与开腹手术(OPEN)治疗胃肠间质瘤的近期疗效的英文文献,利用RevMan 5.3软件进行Meta分析。结果共纳入15篇文献,共计967例胃肠间质瘤患者,其中LAP组500例,OPEN组467例。Meta分析结果显示,与OPEN组比较,LAP组术中出血量更少(WMD=-72.79,95%CI=-118.05-27.53),术后首次排气时间、进食流质时间和住院时间明显缩短(WMD=-0.90,95%CI=-1.11-0.69;WMD=-1.53,95%CI=-2.05-1.02;WMD=-4.13,95%CI=-5.31-2.96),且术后并发症发生率更低(OR=0.39,95%CI=0.240.62)(均P<0.05)。但手术时间差异无统计学意义(WMD=-17.59,95%CI=-39.414.23)(P>0.05)。结论 LAP治疗胃肠间质瘤是安全可行的,且具有良好的近期疗效。

Objective To systematically evaluate the safety,efficacy and short-term results of laparoscopic-assisted resection(LAP)for gastrointestinal stromal tumors(GISTs).Methods A meta-analysis of English literature from July 2005 to July 2015 for comparing LAP and open resection(OPEN)for GISTs was conducted by using Review Manager 5.3 software.Results There were totally 15 studies(967 patients)involved,including 500 cases in LAP group and 467 cases in OPEN group.Meta-analysis results showed that,compared with OPEN,LAP significantly reduced intraoperative blood loss(WMD=-72.79,95%CI=-118.05^-27.53),time to first flatus(WMD=-0.90,95%CI=-1.11^-0.69),time to eating liquid diet(WMD=-1.53,95%CI=-2.05^-1.02),length of hospital stay(WMD=-4.13,95%CI=-5.31^-2.96)and incidence of postoperative complications(OR=0.39,95%CI=0.24~0.62)(P<0.05).There was no significant difference in operation time between the two groups(WMD=-17.59,95%CI=-39.41~4.23)(P>0.05).Conclusion The LAP is a safe and feasible treatment and has a good short-term effect on GISTs.