摘要
目的从循证医学角度评价腹腔镜辅助根治性全胃切除术的安全性和有效性。方法检索2012年2月以前公开发表的对比腹腔镜辅助根治性全胃切除术（LATG组）和开腹根治性全胃切除术（OTG组）的文献。按纳入标准筛选后进行质量评分，提取临床效应指标，采用RevMan5．1软件对所纳入的数据进行荟萃分析。结果本研究共纳入10个对照试验，样本总量942例，其中LATG组422例，OTG组520例。荟萃分析结果显示，与OTG组相比，LATG组手术时间长（WMD=41．12min，95％CI：20．62～61．63，P〈0．01），术中失血量少（WMD=-198．36ml，95％CI：-300．94～-95．78，P〈0．01），术后肛门排气时间早（WMD=-0．80d，95％CI：-1．17～-0．42，P〈0．01），总体并发症少（RR=0．55，95％CI：0．40～0．76，P〈0．01），术后住院时间短（WND=-4．02d，95％CI：-6．03～-2．01，P〈0．01）。两组淋巴结清扫数目、切缘距离及死亡率之间相比差异均无统计学意义（P〉0．05）。结论腹腔镜辅助根治性全胃切除术安全可行，具有术中出血少、术后恢复快和并发症少等优点。
Objective To evaluate the safety and efficacy of laparoscopy-assisted total gastrectomy （LATG） for gastric cancer by systematic review and meta-analysis. Methods The literature database before February, 2012 was extensively searched to retrieve the comparative studies of LATG and open total gastrectomy（OTG） with a relevance of study goal. The inclusion and exclusion criteria were formulated. After a quality evaluation, the data was extracted. The Cochrane collaboration RevMan 5.1 version software was used for meta-analysis. Results There are ten studies meeting the inclusion criteria for meta-analysis. The total sample size of these studies was 942 cases. Compared to OTG, LATG experienced longer operation time [weighted mean difference（WMD） =41.12 min, 95% confidence interval（CI） ： 20. 62 -61.63, P 〈 0. 01 ） ], less blood loss（WMD = - 198.36 ml, 95% CI： - 300. 94 - - 95.78, P 〈 0. 01 ）, earlier time to flatus（ WMD = - 0. 80 days, 95% CI： - 1.17 - - 0. 42, P 〈 0.01 ）, shorter hospital stay（WMD = - 4. 02 days, 95 % CI： - 6.03 - - 2. 01, P 〈 0. 01 ） and decrease in overall complications [ relative risk （RR） = 0. 55, 95% CI： O. 40 - 0.76, P 〈 0. 01 ） ]. The number of dissected lymph nodes, proximal or distal resection margin and mortality were similar between the two groups. Conclusions Laparoscopy-assisted total gastrectomy is a safe and feasible procedure with less blood loss, less overall complications and quick recovery.
出处
《中华普通外科杂志》
CSCD
北大核心
2012年第12期1014-1019,共6页
Chinese Journal of General Surgery
