完整网膜囊切除在胃癌根治术中应用效果的Meta分析

目的:评价胃癌根治术中行完整网膜囊切除的效果。方法:检索2014年10月以前公开发表的比较行完整与不完整网膜囊切除在胃癌根治术中应用情况的文献。按纳入标准筛选后进行质量评分,提取临床效应指标,采用Rev Man 5.0软件对所纳入的数据进行Meta分析。结果:最终纳入7项研究,共1 224例患者,其中完整网膜囊切除组486例,非完整网膜囊切除组738例。Meta分析结果显示,与非完全网膜囊切除组比较,完整网膜囊创伤相关并发症发生率较高(OR=2.1,95%CI=1.05~4.21,P=0.04);术后总并发症情况、肠梗阻、吻合口相关并发症、肺部感染等并发症情况差异无统计学意义(均P>0.05);两组术后3、5年总生存率(OR=1.35,95%CI=0.82~2.21;OR=1.03,95%CI=0.82~1.63)及术后复发率(OR=0.90,95%CI=0.66~1.22)均无统计学差异(均P>0.05)。结论:D1、D2胃癌根治术中进行完整网膜囊切除可能增加创伤相关并发症的风险,在提高患者生存率和降低肿瘤复发率方面无明显优势。

Efficacy of application of bursectomy in radical gastrectomy: a Meta-analysis

Objective: To evaluate the efficacy of bursectomy in radical gastrectomy. Methods: The literature comparing gastrectomy with bursectomy and standard gastrectomy for gastric cancer publicly available by October 2014 was extensively searched. After screening for inclusion, quality assessment and extraction of relevant clinical variables, Meta-analysis of pooled data was performed by the RevMan 5.0 software. Results: Seven studies were finally included involving 1 224 patients, of whom 486 cases underwent gastrectomy with bursectomy (bursectomy group) and 738 cases underwent standard gastrectomy (non-bursectomy group). Results of Meta-analysis showed that the incidence of trauma-related complications in bursectomy group compared with non-bursectomy group was increased (OR=2.1, 95% CI=1.05–4.21, P=0.04); the incidence of overall complications and incidences of lleus, anastomotic complications and lung infection were similar between the two groups (all P>0.05); the postoperative 3- and 5-year survival rate (OR=1.35; 95% CI=0.82–2.21; OR=1.03; 95% CI=0.82–1.63) as well as recurrence rate (OR=0.90, 95% CI=0.66–1.22) had no significant difference between the two group (all P>0.05). Conclusion: Application of bursectomy in D1 and D2 radical gastrectomy may increase the risk of trauma-related complications, and offers no benefit for improvement of postoperative survival or tumor recurrence of the patients.