完全腹腔镜与腹腔镜辅助远端胃癌根治术疗效比较的Meta分析

doi:10.13481/j.1671-587x.20150623

摘要/Abstract

摘要：

目的:探讨完全腹腔镜远端胃癌根治术(TLDG)与腹腔镜辅助远端胃癌根治术(LADG)的安全性和有效性。 方法:计算机检索PubMed、Cochrane Library、中国期刊全文数据库(CNKI)和数字化期刊全文数据库(万方数据库),收集2004—2014年间发表的TLDG与LADG对比的文献,利用RevMan 5.3软件进行Meta分析。结果:共10篇文献被纳入本次Meta分析,共计2 212例胃癌患者,其中TLDG组930例,LADG组1282例。本次Meta分析结果显示,与LADG组比较,TLDG组术中出血少[均数差(WMD)=-20.70,95%CI:-30.81~-10.59,P<0.01]、术后止痛剂使用次数少(WMD=-0.38,95%CI:-0.74~-0.02,P=0.04)和淋巴结清扫数目多(WMD=2.98,95%CI:0.71~5.26,P=0.01),而手术时间、术后首次排气时间、首次进流食时间、术后住院时间、近端切缘距离、术后第1天C反应蛋白水平、术后总体并发症及吻合口并发症发生率比较差异均无统计学意义(均P>0.05)。结论:TLDG治疗远端胃癌安全可行,可取得与传统LADG相当的手术疗效,不增加术后并发症,且具有术中出血少和术后疼痛轻等优点。

关键词: 完全腹腔镜远端胃癌根治术, 腹腔镜辅助远端胃癌根治术, Meta分析

Abstract:

Objective To explore the effectiveness and safety of totally laparoscopic distal gastrectomy (TLDG) and laparoscopically assisted distal gastrectomy (LADG) for gastric cancer. Methods The comparative studies of TLDG and LADG published between 2008 and 2014 were searched from PubMed,EMBASE,Chinese Biomedical Literature Database (CBM),China National Knowledge Infrastructure (CNKI).After screening for inclusion,data extraction,and quality assessment,RevMan 5.3 software was used for Meta-analysis. Results Ten studies of 2 212 patients were included in the Meta-analysis,among whom 930 cases underwent TLDG and 1 282 cases underwent LADG.The results of Meta-analysis indicated that compared with LADG,TLDG had the advantages of less blood loss(WMD=-20.70,95%CI:-30.81--10.59,P<0.01),less usage of analgesic(WMD=-0.38,95%CI:-0.74--0.02,P=0.04),more retrieved lymph nodes(WMD=2.98,95%CI:0.71-5.26,P=0.01).However,the Meta-analysis showed no statistically significant differences in the operation time,postoperative time-to-first flatus and oral intake,postoperative hospital stay,length of proximal resection margin,C reaction protein(CRP) level at postoperative day 1,incidence of overall complications and anastomosis-related complications. Conclusion TLDG is safe and effective with less blood loss,less pain than those of LADG.Moreover,it has comparable results to conventional LADG,with no increase of postoperative complications.

Key words: totally laparoscopic distal gastrectomy, laparoscopically assisted distal gastrectomy, Meta-analysis

中图分类号:

R656.6

陶有茂, 吉国锋, 马冲, 肖玲. 完全腹腔镜与腹腔镜辅助远端胃癌根治术疗效比较的Meta分析[J]. 吉林大学学报(医学版), 2015, 41(06): 1215-1223.

TAO Youmao, JI Guofeng, MA Chong, XIAO Ling. Totally laparoscopic distal gastrectomy and laparoscopically assisted distal gastrectomy:A Meta-analysis on efficacy comparison[J]. Journal of Jilin University Medicine Edition, 2015, 41(06): 1215-1223.

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