消化内镜与腹腔镜治疗胃间质瘤疗效及安全性比较的Meta分析

Efficacy and safety of endoscopic and laparoscopic treatment for gastric stromal tumor: a meta-analysis

目的系统评价消化内镜下切除和腹腔镜手术治疗胃间质瘤(<3.5 cm)的疗效和安全性。方法按Cocharane系统检索策略,收集2000年1月到2018年3月发表的比较消化内镜治疗和腹腔镜治疗胃间质瘤的中英文文献,纳入符合入选标准的10篇文献,使用Revman 5.3软件进行数据分析。结果纳入的10篇文献中,1篇为随机对照试验,其余9篇为回顾性非随机对照试验。患者总数1 062例,内镜治疗组732例,腹腔镜手术组330例。Meta分析结果显示:消化内镜治疗较腹腔镜治疗,手术时间短(MD=-30.58 min,95%CI:-39.31^-21.84,P<0.05)、术中出血量少(MD=-12.99 mL,95%CI:-16.40^-9.57,P<0.05)、住院时间短(MD=-3.17 d,95%CI:-4.76^-1.59,P<0.05)、总费用少(MD=-1.63万元,95%CI:-2.42^-0.84,P<0.05),且切缘阳性率(RR=2.35,95%CI:0.52~10.69,P=0.27)和围术期并发症发生率(RR=1.08,95%CI:0.48~2.42,P=0.85)差异均无统计学意义。结论现有研究显示,在保证完整切除的情况下,消化内镜治疗胃间质瘤具有有效、微创、预后快、经济等优点。

Objective To systematically evaluate the efficacy and safety of endoscopic resection and laparoscopic surgery for gastrointestinal stromal tumors(GIST)(diameter<3.5 cm). Methods According to the Cocharane system search strategy, Chinese and English literature comparing endoscopic with laparoscopic treatment of GIST published from January 2000 to March 2018 were collected. Ten articles meeting the inclusion criteria were included and analyzed with Revman 5.3. Results Of the 10 articles, 1 was a prospective randomized controlled trial and 9 were retrospective non-randomized controlled trials. The total number of patients was 1 062. There were 732 cases in the endoscopic treatment group, and 330 cases in the laparoscopic surgery group. The meta-analysis results showed that the endoscopic treatment group had shorter operation time (MD=-30.58 min, 95%CI:-39.31--21.84, P<0.05), less blood loss (MD=-12.99 mL, 95%CI:-16.40--9.57, P<0.05), shorter hospital stay (MD=-3.17 d, 95%CI:-4.76--1.59, P<0.05), and less total cost (MD=-1.63 ten thousand RMB, 95%CI:-2.42--0.84, P<0.05) than those of the laparoscopic group. But there were no significant differences in the positive rate of margin(RR=2.35, 95%CI: 0.52-10.69, P=0.27) or perioperative complications(RR=1.08, 95%CI: 0.48-2.42, P=0.85). Conclusion Existing studies have shown that endoscopic treatment for GIST is effective, minimally invasive, economical with better prognosis, ensuring complete resection.