内镜黏膜下剥离术与外科手术治疗早期胃癌的有效性及安全性的Meta分析

发布时间：2018-07-04 12:26

本文选题：早期胃癌 + 内镜黏膜下剥离术　；参考：《中国内镜杂志》2017年05期

【摘要】：目的内镜黏膜下剥离术(ESD)与外科手术是早期胃癌(EGC)的常用治疗方法,但其相关风险及获益目前仍存在争议,该研究旨在比较两种治疗方法在治疗EGC的有效性、安全性等方面的差异。方法检索1990年1月-2016年6月发表在Pubmed、CBM、Embase、Cochrane Library、中国知网数据库、维普数据库及万方数据库的有关ESD与外科手术治疗EGC对比研究的所有中英文文献,根据纳入和排除标准对搜索的相关文献进行二次筛选,并对纳入的研究进行质量评价,采用Revman 5.3软件进行Meta分析。结果总共有12篇文献符合纳入标准,且均为回顾性队列研究,共涉及4 331个研究对象。Meta分析的结果显示:ESD与外科手术相比,复发率[(22/2 586,0.85%)vs(6/1 134,0.53%),P=0.370]及5年生存率[(852/909,93.72%)vs(707/746,94.77%),P=0.340]差异无统计学意义,虽然外科手术在整块切除率方面稍高于ESD组[(99/99,100.00%)vs(95/103,92.23%),P=0.020],但是外科手术组的手术时间[标准化均数差(SMD)=-3.04,95%CI:-3.64~-2.45,P=0.000]及住院时间(SMD=-2.53,95%CI:-3.73~-1.32,P=0.000)比ESD组延长,且术后并发症增多[(45/816,5.50%)vs(101/686,14.72%),P=0.000]。结论对于EGC的治疗,两种治疗方法在复发率及5年生存率方面无明显差异,虽然ESD组在整块切除率上不及外科手术组,但其具有创伤小、手术时间短、术中及术后并发症少、住院时间短且恢复快等显著优势,可作为EGC的首选治疗方法。
[Abstract]:Objective Endoscopic submucosal dissection (ESD) and surgery are commonly used in the treatment of early gastric cancer (EGC), but the risks and benefits of EGC are still controversial. The purpose of this study is to compare the effectiveness of the two treatments in the treatment of EGC. Differences in safety, etc. Methods all the Chinese and English literatures on ESD and surgical treatment EGC were retrieved from January 1990 to June 2016, published in Pubmedmedus CBMN Embase Library, China knowledge Network Database, Weip Database and Wanfang Database. According to the criteria of inclusion and exclusion, the search literature was screened twice, and the quality of the included research was evaluated. The Meta-analysis was carried out by Revman 5.3 software. Results A total of 12 articles met the inclusion criteria and were all retrospective cohort studies. A meta-analysis of 4 331 subjects showed that the recurrence rate [(22 / 2 5860.85%) of) vs (6 / 1 134 / 0.53%] and the 5-year survival rate [(852 / 9092%) vs (70774% or 94.77%) P0.340] had no statistical significance. Although the surgical resection rate was slightly higher than that in the ESD group [(99 / 99100.00%) vs (95 / 10392.23%) P0. 020], the surgical operation time [SMD] was 3.0495CI-3.64CI-2.45P0.000, and the length of stay (SMD-2.53-95CI- 3.73P0.000) was longer than that in the ESD group, and the postoperative complications increased [(458165.50%) vs (101686n 14.72%) P0.000]. Conclusion there is no significant difference in the recurrence rate and 5-year survival rate between the two methods in the treatment of EGC. Although the whole resection rate of ESD group is lower than that of the surgical group, the ESD group has less trauma, shorter operative time and less complications during and after operation. The advantages of short hospital stay and quick recovery can be used as the first choice of treatment for EGC.
【作者单位】：南昌大学第一附属医院消化内科;
【分类号】：R735.2

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