摘要
背景:目前已有部分学者进行了腹腔镜胃癌手术前瞻性随机对照研究来评价其可行性及安全性,但其结果略有差异。目的:系统评价腹腔镜胃癌手术的可行性与安全性。方法:运用计算机检索PubMed,Ovid Medline,Web of knowledge,EMbase,中国期刊全文数据库和万方数据库(1994-01/2009-12)。所纳入文献均为前瞻性随机对照研究,均为关于腹腔镜和开腹胃癌手术的比较类文章。采用RevMan5.0软件对所得数据进行Meta分析,对连续性数据的统计用倒方差法,而分支数据采用M-H法,用χ2检验来评价异质性,对非同质数据的统计采用自由效应模型,同质数据采用固定效应模型,统计数据以95%可信区间表示,用漏斗图对相关指标进行敏感性分析,从而发现可能存在的发表偏倚。结果与结论:共纳入5篇符合要求的文献,包括326个病例,其中腹腔镜手术164例,开腹手术162例。Meta分析的结果提示:腹腔镜胃癌根治术的手术时间较开腹手术长(P<0.01),淋巴结清扫的数量也较开腹手术少(P<0.01);但在术中出血量及住院天数方面,腹腔镜早期胃癌手术优于开腹手术(P<0.01);而恢复经口进食时间、手术并发症、术后早期的死亡率、肿瘤复发率方面两组差异无显著性意义。敏感性分析的结果显示,除淋巴结清扫外,其他各指标都存在不同程度的发表偏倚。因所得5篇文献采用了两种不同的淋巴结清扫方式,对其进行亚组分析,结果显示D1式淋巴结清扫时,腹腔镜手术的出血量明显均较开腹手术少。结果提示早期胃癌患者行腹腔镜手术是安全、可行的。
BACKGROUND：There have been some prospective,randomized,controlled studies regarding the feasibility and safety of laparoscopic gastrectomy for gastric cancer,but controversy exists.OBJECTIVE：To systemically assess the feasibility and safety of laparoscopic gastrectomy for gastric cancer.METHODS：A computer-based online research of prospective,randomized,controlled studies addressing laparoscopic gastrectomy versus open gastrectomy published between January 1994 and December 2009 was performed in PubMed,Ovid Medline,Web of Knowledge,EMbase,Chinese Journal Full-text Database and Wanfang Database.Meta analysis of acquired data was performed through the use of RevMan 5.0 software.The inverse variance method was used to test the significance of continous data,while the Mantel-Haenszel method was used for dichotomous data.The chi-square test was used for evaluation of data heterogeneity.Homogenous data was calculated using the fixed effect model,and heterogeneous data was calculated using freedom model.Statistical data was expressed as 95% confidence interval.Funnel plot was used for sensitivity analysis to show potential publication bias.RESULTS AND CONCLUSION：Five papers that corresponded to inclusion criteria were included in this study.Among 326 cases included,164 underwent laparoscopic gastrectomy and 162 received open gastrectomy.Meta analysis revealed that laparoscopic gastrectomy took longer operating time and removed fewer lymph nodes than open gastrectomy（both P 0.01）,but for early-stage gastric cancer,laparoscopic gastrectomy was superior to open gastrectomy in terms of blood loss and hospital stay（P 0.01）.But there was no significant difference in terms of time to resumption of oral intake,postoperative complications,postoperative morbidity rate,and tumor recurrence.Sensitive analysis demonstrated that publication bias existed in all indices to different extents with the exception of lymph node.The five papers adopted two different modes to remove lymph nodes,so subgroup analysis was also used.Results showed that for D1 lymph node dissection,laparoscopic gastrectomy took significantly reduced blood loss than open gastrectomy.All these findings indicate that laparoscopic gastrectomy for early stage gastric cancer is feasible and safe.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2010年第46期8726-8731,共6页
Journal of Clinical Rehabilitative Tissue Engineering Research
