完全腹腔镜与腹腔镜远端胃癌根治术疗效的Meta分析

目的：比较完全腹腔镜远端胃癌根治术（TLDG）与腹腔镜辅助远端胃癌根治术（LADG）的有效性及安全性，探讨完全腹腔镜技术在远端胃癌根治术中的应用价值。方法检索 PubMed 公开发表的完全腹腔镜与腹腔镜辅助远端胃癌根治术比较的研究文献。通过采用RevMan 5.0统计软件，合并及比较两者手术时间、淋巴结清扫数目、术中出血、术后首次排气时间、术后并发症及住院时间等指标，选择计算优势比（OR，95%的可信区间）和加权均数差（WMD，95%的可信区间）作为效应尺度来评估两种术式的安全性和有效性。结果6项研究文献被纳入本次Meta分析，其中实施完全腹腔镜远端胃癌根治术656例，腹腔镜辅助远端胃癌根治术988例，共1644例患者。本项Meta分析结果显示，与腹腔镜辅助远端胃癌根治术相比，实施完全腹腔镜远端胃癌根治术的患者术中出血少、术后首次排气时间早、住院时间短（合并WMD分别为-17.79，95%CI -32.57～-3.02，P＝0.02；-0.14，95%CI -0.23～-0.06，P＝0.001；-0.32，95%CI -0.53～-0.12，P＝0.002），而在手术时间、淋巴结清扫数目、术后并发症的发生率方面，两种术式差异无统计学意义（合并WMD为11.19，95%CI -4.54～26.92，P＝0.16；3.55，95%CI -0.18～7.28，P＝0.06；合并OR为1.27，95%CI 0.86～1.88，P＝0.22）。结论 TLDG是安全可行的，与传统LADG具有相似的手术疗效。然而，在术中出血、术后胃肠道功能恢复方面，TLDG 更具优势，但仍然需要开展大样本的临床对照试验来进一步验证这一结论。

Investigate the application value of totally laparoscopic distal gastrectomy for gastric cancer

Objective This study aimed to compare totally laparoscopic distal gastrectomy （TLDG） to laparoscopically assisted distal gastrectomy （LADG）, then to investigate the potential advantages and application value of TLDG. Methods Studies and relevant literatures comparing TLDG to LADG were searched though PubMed. Operative time, number of retrieved lymph nodes, volume of bleeding, time to first flatus, duration of postoperative hospitalization and postoperative complications were pooled and compared using RevMan 5.0. Odds ratios （OR） and weighted mean differences （WMD） were calculated with 95%confidence intervals （CI） to evaluate the effect of TLDG. Results Six recent studies of 1644 patients were included in the meta-analysis. Compared with LADG, TLDG had advantages of less bleeding （WMD -17.79, 95% CI -32.57 to -3.02, P=0.02）, shorter time to first flatus （WMD -0.14, 95% CI -0.23 to -0.06, P=0.001） and shorter postoperative hospitalization （WMD -0.32, 95% CI -0.53 to -0.12, P=0.002）. Operative time, mean number of lymph nodes retrieved and postoperative complication rate were not statistically different （WMD 11.19, 95%CI -4.54 to 26.92, P=0.16;3.55, 95%CI -0.18 to 7.28, P=0.06;OR 1.27, 95%CI 0.86 to 1.88, P=0.22）. Conclusions TLDG appears to have comparable results to conventional LADG in the hands of experienced surgeons. More over, TLDG has the relative benefits of surgical trauma and postoperative recovery to LADG, it has broad application value and development prospects. Large scale clinical studies are needed to conduct.