腹腔镜与开腹手术治疗老年胃癌患者疗效的Meta分析

目的:対比分析腹腔镜与幵腹手术治疗老年胃癌患者的临床疗效。方法:检索2016年10月前发表于PubMed、Embase,MEDLINE,Cochrane Library、万方数据库、中国期刊全文数据库(CNKI)、中国生物医学期刊文献数据库(CMCC)及维普数据库中対比腹腔镜与开腹手术治疗老年胃癌患者临床疗效的文献。按预设标准进行筛选并进行质量评价,提取数据后用RevMan 5.2软件对两组患者手术指标、术后恢复情况及术后并发症进行Meta分析。结果:有19项对照研究共计2 951例患者纳入分析,其中腹腔镜组1387例,开腹组1 564例。Meta分析结果显示,与幵腹组相比,腹腔镜组术中出血量少(MD=415.85,95%CI:-414.66~-87.04,P=0.00),淋巴结清扫数量多(MD=0.62,95%CI:0.06~1.19,P=0.03)。腹腔镜组术后首次下床活动时间、术后首次肛门排气时间、术后首次经ロ进食时间及术后住院时间均短于开腹组(P0.05)。两组手术时间差异无统计学意义(MD=6.44,95%CI:-5.83~18.72,P=0.30)。腹腔镜组术后总体并发症、手术相关并发症、呼吸系统并发症及切口并发症发生率均低于开腹组(P0.05)。结论:与开腹老年胃癌根治术相比腹腔镜老年胃癌根治术同样安全、可行且具有手术创伤小、术后康复快、并发症发生率低的优势。

Meta analysis of clinical efficacy compared between laparoscopic gastrectomy and open gastrectomy for elderly patients with gastric cancer

Objective:To compare the clinical efficacy between laparoscopic gastrectomy ( LG) and open gastrectomy ( OG) in elderly patients with gastric cancer. Methods:Clinical studies that compared clinical outcomes of LG and OG for elderly patients were searched from PubMed,Embase,MEDLINE,Cochrane Library,WanFang,CNKI,CMCC and VIP database before Oct. 2016. The studies were filtrated according to pre-established criteria and their qualities were evaluated. Data of operation,postoperative recovery and com-plications were analyzed using RevMan 5. 2 software. Results:Nineteen studies including 2 951 cases were enrolled. There were 1 387 patients in LG group and 1 564 patients in the OG group. Result of meta-analysis showed that LG was associated with less intraoperative blood loss (MD=-115. 85,95%CI:-114. 66~-87. 04,P=0. 00),more harvested lymph nodes (MD=0. 62,95%CI:0. 06-1. 19,P=0. 03) ,earlier time to first ambulation,first flatus,oral intake,shorter hospital stay,fewer overall postoperative and surgical complication, pulmonary and incision complications (P<0. 05). There was no significant difference in the operation time between the 2 groups (MD=6. 44,95%CI:-5. 83-18. 72,P=0. 30). Conclusions:Compared with OG,LG is safe,feasible and mini-invasive for treating gastric cancer in elderly patients,with the advantages of rapider postoperative recovery and fewer postoperative complications.