完全腹腔镜与腹腔镜辅助远端胃癌根治术对比研究的meta分析

目的：从循证医学角度比较完全腹腔镜与腹腔镜辅助远端胃癌根治术的安全性和微创效果。方法：检索PubMed、Cochrane library、Web of Science和Biosis Previews 数据库收录的2014年6月前公开发表的对比完全腹腔镜远端胃癌根治术（TLDG组）和腹腔镜辅助远端胃癌根治术（LADG组）的文献。对其中的手术时间、术中出血量、术后肛门排气时间、进食时间、住院时间、并发症发生率及术后镇痛药物使用次数、疼痛评分、第1天和第7天C反应蛋白（CRP）水平等数据进行meta分析。数据分析使用RevMan 5.1软件。结果：共纳入7个对照研究，样本总量1783例，其中TLDG组727例，LADG组1056例。结果显示：与LADG组相比，TLDG组术中出血量少［加权均数差（WMD）=22.86 ml， 95% CI: 12.00 ～ 33.72， P < 0.01），术后镇痛药物使用次数少（WMD=0.58， 95% CI: 0.35 ～ 0.81，P < 0.01），术后第1、3天疼痛评分低（第1天: WMD=0.60， 95% CI: 0.20 ～ 0.99，P < 0.01; 第3天: WMD=0.36， 95% CI: 0.24 ～ 0.48，P < 0.01），进食时间早（WMD=0.66 d， 95% CI: 0.13 ～1.19，P =0.01）。两组手术时间、术后住院时间、总体并发症及吻合口并发症发生率以及术后第1、7天CRP水平差异均无统计学意义（均P > 0.05）。结论：TLDG手术安全可行，相比于LADG手术具有术中出血少、术后疼痛轻、恢复快及术后早期炎症反应轻等优点。

Totally laparoscopic versus laparoscopic assisted distal gastrectomy for gastric cancer: a meta-analysis

Objective: To compare the safety and efficacy of totally laparoscopic distal gastrectomy （TLDG）with laparoscopic assisted distal gastrectomy （LADG）for gastric cancer by meta-analysis. Methods: The literature on comparative studies of TLDG and LADG up to June 2014 were extensively retrieved from database PubMed, Cochrane library, Web of Science, and Biosis Previews. The operation time, blood loss, time to flatus, time to first oral intake, postoperative hospital stay, postoperative morbidity, times of analgestic requirement, pain score, and the level of C-reactive protein （CRP）on postoperative day 1 and 7 were analyzed. The statistical analysis was performed with RevMan 5.1 software. Results: Seven studies met the inclusion criteria for meta-analysis. A total of 1783 Patients were included for meta-analysis, among whom 727 cases underwent TLDG and 1056 underwent LADG. Comparing with LADG, TLDG experienced less blood loss ［weighted mean difference （WMD）=22.86 ml, 95% confidence interval （CI）: 12.00-33.72,P < 0.01］, less times of analgesic requirement （WMD=0.58, 95% CI: 0.35-0.81,P < 0.01）, less pain score on postoperative day 1 and day 3 （day1: WMD=0.60, 95% CI: 0.20-0.99, P < 0.01; day3: WMD=0.36, 95% CI: 0.24-0.48, P < 0.01）, earlier beginning to take diet（WMD=0.66 d, 95% CI: 0.13-1.19,P= 0.01）. The operation time, postoperative hospital stay, overall morbidity and anastomosis-related morbidity, and the level of CRP on postoperative day 1 and 7 were similar between two groups （Ps>0.05）. Conclusion: TLDG is a safe and feasible procedure with less blood loss, less pain, and quicker recovery than those of LADG.