早期远端胃癌腹腔镜与传统开腹手术淋巴结清扫数目比较的Meta分析

目的对比分析对于早期远端胃癌患者行腹腔镜与传统开腹手术淋巴结清扫的数目。方法检索福建医科大学图书馆网页2000年1月至2008年12月间MEDLINE、EMBASE及TheCochraneLibrary等数据库和中国期刊全文数据库（CNKI）及中国生物医学期刊文献数据库（CMCC）有关比较早期远端胃癌腹腔镜与传统开腹手术淋巴结清扫数目的文献。由3位胃肠外科医生各自独立地对入选研究的有关试验设计、研究对象特征和研究结果等内容进行摘录，并用RevMan5．0软件进行统计分析。结果按筛选标准，共有14篇文献入选。全体研究样本量合计早期远端胃癌患者1454例，其中腹腔镜手术（LADG）组815例，传统开腹手术（CODG）组639例。分析结果显示，LADG组清扫淋巴结数目比CODG组少3．26枚／例，其加权均数差（WMD）为-3．26[95％CI-6．24～0．27，P=0．03]，差异具有统计学意义。但对其进行敏感性分析显示：2005—2008年发表的文献、D1＋α／β淋巴结清扫、回顾性非随机对照研究等3个亚组的LADG和CODG清扫的淋巴结数目相似，其WMD分别为-2．84[95％CI-6．79～1．11，P=0．16]和-2．80[95％CI-7．57～1．97，P=0．251及-2．89[95％CI-6．48～0．70，P=0．11]，差异无统计学意义。结论随着腹腔镜外科医师技术逐渐成熟，对早期远端胃癌进行D1＋α／β淋巴结清扫术，LADG和CODG清扫的淋巴结数目相当。

Laparoscopic versus conventional open resection for early distal gastric cancer: a Meta-analysis on the number of retrieved lymph nodes

Objective To compare the number of retrieved lymph nodes (LN) between laparoscopic resection and conventional open resection for early distal gastric cancer with meta-analysis. Methods Original articles published from January 2000 to December 2008 were searched in the MEDLINE,EMBASE and Cochrane Controlled Trials Register. According to the criterion, 14 articles were identified which compared the number of retrieved lymph nodes between laparoscopic resection and conventional open resection for early distal gastric cancer. Data were extracted from these trials by 3 reviewers independently and analyzed by Rev Man 5.0 software. Results A total of 1454 patients with early gastric cancer were enrolled, including 815 patients in the laparascopic group and 630 patients in the conventional group. The mean number of dissected lymph nodes per patient was 3.26 less in the laparoscopic group as compared to the conventional group(WMD -3.26,95% CI -6.24--0.27,P=0.03).The differences were not statistically significant in the articles published during 2005-2008 years (WMD -2.84, 95% CI -6.79-1.11, P=0.16), in D_1~++α/β lymph node dissection(WMD-2.80, 95% CI -7.57-1.97, P=0.25), and in retrospective non-randomized trials(WMD -2.89, 95% CI -6.48-0.70, P=0.11).Conclusion With the improvement in surgical skills, laparoscopic surgery and open surgery do not differ significantly in the number of retrieved lymph nodes for early distal gastric cancer with D_1~++α/β lymph node dissection.