快速康复外科联合腹腔镜胃癌根治术安全性和有效性的系统评价

目的系统评价快速康复外科（FTS）联合腹腔镜胃癌根治术的安全性和有效性。方法计算机检索1994年1月至2012年12月CNKI、万方、维普、PubMed、EMBASE、CochraneLibrary数据库关于glS联合腹腔镜对照两者单独应用于胃癌根治术的随机对照试验（RCT）或临床对照试验（CCT），对符合标准的文献提取相关数据后采用RevMan5．1．0软件进行Meta分析。结果3项RCT和2项CCT纳入研究，共有524例患者，其中试验组（gl＇S联合腹腔镜）257例，对照组（单纯FTS或单纯腹腔镜）267例。Meta分析结果显示：试验组较对照组术后首次排气时间明显提前（SMD=-1．29，95％CI：-2．17—0．40．P〈0．05）．住院时间明显缩短（WMD=-1．72，95％CI：-2．56—0．89，P〈0．05），术后并发症发生率明显降低（OR=0．51，95％CI：0．31～0．84，P〈0．05），但手术时间、淋巴结清扫数量、术中出血量和住院费用方面两组差异无统计学意义（均P〉0．05）。结论FTS联合腹腔镜胃癌根治术能有效促进术后肠功能恢复，缩短住院时间，减少术后并发症，加速患者康复。

Systemic review of the safety and efficacy of fast-track surgery combined with laparoscopy in radical gastrectomy for gastric cancer

Objective To conduct a systemic review of the safety and efficacy of fast-track surgery combined with laparoscopy in radical gastrectomy for gastric cancer. Methods The databases, including CNKI, Wangfang, VIP, PubMed, EMBASE and Cochrane Library, were searched to collect randomized controlled trials （RCTs） or clinical controlled trials （CCTs） on the comparison of fast-track surgery combined with laparoscopy versus fast-track surgery or laparoscopy separately used in radical gastreetomy for gastric cancer between January 1994 and December 2012. After data were extracted, meta-analysis was conducted by using RevMan 5.1.0 software. Results A total of 3 RCTs and 2 CCTs, involving 524 patients, were included. There were 257 patients in the study group and 267 patients in the control group. Compared with the control group, the study group had earlier first flatus （SMD=-l.29, 95%CI： -2.17 to -0.40,P〈0.05）, shorter postoperative hospital stay（WMD=-l.72,95% CI： -2. 56 to -0.89,P〈0.05） and lower postoperative complication rate （0R=0.51,95%CI：0.31 to 0.84,P〈0.05）. However, no significant differences were found in operation time, harvested lymph node number, intraoperative blood loss and hospital charge （P〉0.05）. Conclusion Fast-track surgery combined with laparoseopy in radical gastrectomy for gastric cancer can accelerate postoperative rehabilitation by promoting postoperative bowel function recovery, and decreasing postoperative hospital stay and complication rate.