腹腔镜全胃切除术治疗进展期胃癌安全性与有效性的Meta分析

目的：系统评价腹腔镜全胃切除术治疗进展期胃癌的手术安全性和淋巴结清扫程度。 方法：计算机检索多个国内外文献数据库，收集腹腔镜全胃切除术对比开腹全胃切除术治疗进展期胃癌所有随机对照试验和回顾性研究，检索时间截止2014年3月。根据纳入和排除标准筛选文献、提取资料和进行质量评价，用RevMan 5.2软件进行Meta分析。 结果：最终纳入6篇文献，共1 115例，其中腹腔镜手术547例，开腹手术568例。Meta分析显示，与开腹全胃切除术相比，腹腔镜全胃切除术治疗进展期胃癌术后并发症少、术中出血量少、术后住院时间短，但手术时间较长（均P<0.05）；淋巴结清扫数目差异无统计学意义（P>0.05）。 结论：腹腔镜全胃切除术治疗进展期胃癌与开腹全胃切除术相比有一定的微创优势，手术安全性好，且淋巴结清扫程度相似。

Safety and effectiveness of laparoscopic total gastrectomy for advanced gastric cancer: a Meta-analysis

Objective: To systematically evaluate the safety and degree of lymph node dissection of laparoscopic total gastrectomy for advanced gastric cancer. Methods: The randomized controlled trials or retrospective studies comparing laparoscopic total gastrectomy and open total gastrectomy for advanced gastric cancer were collected by searching several national and international databases. Data collection ended in May 2013. After screening for inclusion, data extraction, and quality assessment, Meta-analysis was performed by the RevMan 5.2 software. Results: Six studies were finally selected involving 1 115 patients, of whom 547 underwent laparoscopic surgery and 568 cases were subjected to open surgery. Results of the Meta-analysis showed that laparoscopic total gastrectomy versus open surgery for advanced gastric cancer reduced the incidence of complications, intraoperative blood loss and length of hospital stay; but prolonged the operative time (all P<0.05), and however, made no statistical difference in number of dissected lymph nodes (P>0.05). Conclusion: Compared with open surgery, laparoscopic total gastrectomy for advanced gastric cancer is superior in minimal invasion and safety, and can achieve a similar lymph node dissection effect.