摘要
目的评价胃癌根治术腹主动脉旁淋巴结清扫的安全性与有效性。方法2位评价者制定检索策略，利用PubMed和Medline等数据库检索胃癌手术腹主动脉旁淋巴结清扫的随机对照研究，运用固定效应模型与随机效应模型对术中腹主动脉旁淋巴结清扫与否的两组胃癌患者手术的安全性与有效性进行Meta分析。结果符合入选标准的随机对照临床试验7项共计胃癌根治术患者1446例。与非腹主动脉旁淋巴结清扫组比较，腹主动脉旁淋巴结清扫组患者术后并发症总发生率升高（RR1．34，95％CI1．03～1．75，P=0．03）：术后出现淋巴瘘和严重腹泻者增多（RR分别为16．23和9．56，95％CI分别为1．99～131．98和1．70～53．67）；而术后吻合口瘘、胰瘘、腹腔脓肿、肠梗阻、出血和伤口感染等发生率未见明显升高。腹主动脉旁淋巴结清扫组术中出血量及输血人数比例增加（WMD202．95，95％CI116．80．289．10：RR1．93，95％CI1．20。3．10：均P〈0．05），但手术时间、平均输血量、平均术后住院天数、再次手术率、术后复发率和5年生存率等与D2／D3术式相近。结论腹主动脉旁淋巴结清扫术后并发症总发生率升高，并不能降低术后复发率、提高生存率，其临床疗效尚有待更严格的、多中心的、具有长期随访的大宗病例研究来证实。
Objective To evaluate the safety and efficacy of paraaortic lymphadenectomy in gastric cancer with meta-analysis. Methods Randomized controlled trial comparing D2/D3 and D2/D3 plus paraaortic lymphadenectomy in gastric cancer were identified by two investigators after search strategy was established. Seven randomized controlled trials with 1446 cases were included in this meta-analysis. Fixed effect model or random model was separately used to evaluate the safety and efficacy of paraaortic lymphadeneetomy in gastric cancer. Results Total complication rate in the D2/D3 plus paraaortie lymphadenectomy group was significantly higher than that in the D2/D3 group（RR 1.34,95% CI 1.03- 1.75,P=0.03）, while surgery associated complication between the two groups was almost the same. Lymphorrhea and severe diarrhea was more common in the D2/D3 plus paraaortic lymphadenectomy （RR 16.23 and 9.56, 95% CI 1.99-131.98 and 1.70-53.67, respectively）. Anastomotic leak, pancreatic fistula, abdominal abscess, ileus, postoperative bleeding and wound infection were similar. There were no advantages in operating time, amount of blood transfusion, in-hospital stay, reoperation, recurrence and 5-year survival favoring the paraaortic lymphadeneetomy group except intra-operative blood loss and rate of blood transfusion（WMD 202.95, 95% CI 116.80-289.10; RR 1.93, 95% CI 1.20-3.10）. Conclusions Paraaortic lymphadenectomy is associated with increased total complication without altering postoperative recurrence and survival. Strict large-scale muhicenter controlled trials with long-term follow-up are required.
出处
《中华胃肠外科杂志》
CAS
北大核心
2010年第2期119-124,共6页
Chinese Journal of Gastrointestinal Surgery
关键词
胃肿瘤
主动脉
腹
胃切除术
淋巴结清扫术
META分析
Stomach neoplasms
Aorta, abdominal
Gastrectomy
Lymph node dissection
Meta analysis
