腹腔镜与开腹远端胃癌根治术治疗进展期胃癌近期疗效Meta分析

发布时间：2019-02-11 20:30

【摘要】：目的:系统性评价对进展期胃癌患者行腹腔镜远端胃癌根治术的近期疗效和安全性。方法:检索国内外数据库如:Pubmed、Medline、Cochrane、CNKI、VIP、EMbase、CBM、中国生物医学文献数据库、相关期刊论文等。搜索其建库至今的所有公开发表的有关于进展期胃癌患者行腹腔镜远端胃癌根治术对比开腹手术的文章。纳入所有符合标准的随机对照试验(randomized controlled trial)和回顾性研究。由两位独立研究人员提取资料,并参照Cochrane系统评价手册对纳入研究的方法学质量进行评估后,所收集的数据采用Review Manager4.2进行Meta分析。结果:根据上述检索策略以本文的纳入、排除标准,共9项回顾性研究及3项随机对照试验纳入本分析。12篇文章共收集病例1127例,其中腹腔镜组(LDG组)527例,开腹组(ODG组)600例。Meta分析结果显示:腹腔镜组较开腹组行远端胃癌根治术手术时手术时间长,(MD=26.97,95%CI=23.59~30.36,P0.00001)。术中出血量少,(MD=-94.76,95%CI=-101.29~-88.24,P0.00001)。淋巴结清扫数目无差异,(MD=-0.20,95%CI=-0.50~0.10,P=0.19)。术后第一次排气时间较短,(MD=-1.06,95%CI=-1.15~-0.97,P0.00001)。术后第一进食流质时间较短,(MD=-1.62,95%CI=-1.80~-1.44,P0.00001)。术后住院时间短,(MD=-1.99,95%CI=-2.25~-1.73,P0.00001)。术后并发症少,(OR=0.43,95%CI=0.30~0.62,P0.00001)。结论:与传统开腹手术相比,进展期胃癌病人行腹腔镜远端胃癌D2根治术时可以取得与开腹手术一样的近期疗效,并且腹腔镜远端胃癌根治术创伤更小,患者恢复速度更快。但腹腔镜D2胃癌根治术的长期疗效仍需要大样本的试验数据来证实。
[Abstract]:Objective: to evaluate the efficacy and safety of laparoscopic distal radical gastrectomy in patients with advanced gastric cancer. Methods: domestic and foreign databases such as Pubmed,Medline,Cochrane,CNKI,VIP,EMbase,CBM, Chinese Biomedical Literature Database and Chinese Journal Full-text Database were searched. Search for all published articles about laparoscopic distal radical gastrectomy in patients with advanced gastric cancer. All eligible randomized controlled trial (randomized controlled trial) and retrospective studies were included. The data were extracted by two independent researchers and the quality of the methodology included in the study was evaluated according to the Cochrane system evaluation manual. The collected data were analyzed by Review Manager4.2 for Meta analysis. Results: according to the above retrieval strategy, 9 retrospective studies and 3 randomized controlled trials were included in this analysis. 1127 cases were collected in 12 articles, including 527 cases in the laparoscopic group (LDG group). The results of Meta analysis showed that the operation time of distal gastric cancer in laparoscopic group was longer than that in laparotomy group (MD=26.97,95%CI=23.59~30.36,P0.00001). The amount of intraoperative bleeding was less (MD=-94.76,95%CI=-101.29~-88.24,P0.00001). There was no difference in the number of lymph node dissection (MD=-0.20,95%CI=-0.50~0.10,P=0.19). The first time after operation was shorter (MD=-1.06,95%CI=-1.15~-0.97,P0.00001). The first feeding time after operation was shorter (MD=-1.62,95%CI=-1.80~-1.44,P0.00001). Postoperative hospital stay was short (MD=-1.99,95%CI=-2.25~-1.73,P0.00001). There were few postoperative complications (OR=0.43,95%CI=0.30~0.62,P0.00001). Conclusion: compared with the traditional open operation, laparoscopic D 2 radical gastrectomy for advanced gastric cancer patients can achieve the same short-term curative effect as open surgery, and laparoscopic distal gastric cancer surgery has less trauma and faster recovery rate. However, the long-term efficacy of laparoscopic D 2 radical gastrectomy still needs large sample data to confirm.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R735.2

【相似文献】