腹腔镜辅助下胃癌D2根治性远端胃大部切除术安全性与有效性的系统评价

目的 评价腹腔镜辅助下胃癌D2根治性远端胃大部分切除术的安全性与有效性.方法 检索Pubmed、Medline、EMBASE和中国生物医学数据库(CBM)2001年1月至2010年2月间发表的D2根治性远端胃大部分切除术治疗胃癌的对照试验研究,用Revman 5.0统计软件进行分析.结果 共纳入7个对照试验,其中1项研究为随机对照试验,6项为非随机对照研究.腹腔镜辅助远端胃大部分切除组(LADG)与开腹远端胃大部切除术(ODG组)相比,术中出血量少[加权均数差(WMD)=-132.04,95% CI:-207.32～-56.77],术后第1次排气时间早(WMD=-0.82,95% CI:-1.20～-0.45),术后并发症发生率低[相对危险度(OR)=0.45,95%CI:0.26～0.78],术后住院时间短(WMD=-3.63,95%CI:-4.19～-3.07),清扫的淋巴结数目多(WMD=1.93,95%CI:0.36～3.50);但术后复发率、转移率和近期(3年内)生存率差异无统计学意义(P＞0.05).结论 腹腔镜辅助下胃癌D2根治性远端胃大部分切除术的短期效果优于开腹手术.

Systematic review on safety and efficacy of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for gastric cancer

Objective To evaluate the safety and efficacy of laparoscopy-assisted distal gastrectomy (LADG) with D2 lymph node dissection for gastric cancer.Methods Literature search was performed in Pubmed,Medline,EMBASE,the Chinese Biomedical Database (CBM) to identify controlled trials comparing LADG and open distal gastrectomy (ODG)for gastric cancer published between January 2005 and February 2010.A meta-analysis was performed using RevMan 5.0 software.Results Seven controlled trials were included.One trail was randomized controlled trial.Compared to ODG,LADG had less blood loss[WMD:-132.04,95% confidence interval(CI):-207.32 to -56.77],earlier postoperative first flatus (WMD:-0.82,95% CI:-1.20 to -0.45],less complications [odds ratio(OR):0.45,95% CI:0.26 to 0.78],shorter postoperative hospital stay(WMD:-3.63,95% CI:-4.19 to -3.07),more harvested lymph nodes (WMD:1.93,95% CI:0.36 to 3.50).There were no significant differences between the two groups in recurrence rate,metastasis rate,mortality and survival rate.Conclusion Short-term outcome of LADG with D2 lymph node dissection for gastric cancer is superior to ODG.