中国普外基础与临床杂志

中国普外基础与临床杂志

腹腔镜辅助胃癌根治术与传统开放胃癌根治术治疗老年胃癌患者安全性及疗效比较的 meta 分析

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目的 系统评价腹腔镜辅助胃癌根治术(LAG)与传统开放胃癌根治术(COG)治疗老年胃癌患者的安全性及疗效。 方法 计算机检索 Pubmed、EMBASE、Web of Science、Cochrane Library、中国期刊全文数据库(CNKI)、万方数据库及维普数据库中的有关 LAG 与 COG 治疗老年胃癌患者疗效比较的文献,采用 RevMan 5.2 软件行 meta 分析。 结果 最终纳入 10 篇文献,累计样本量为 1 522 例,其中观察组 757 例,对照组 765 例。meta 分析结果显示:对于老年胃癌患者,与 COG 比较,LAG 的术中出血量少[MD=–121.12,95%CI 为(–179.93,–62.31),P<0.000 1],术中淋巴结清扫数量多[MD=1.62,95%CI 为(0.60,2.65),P=0.002],术后首次下床活动时间[SMD=–0.94,95%CI 为(–1.46,–0.43),P=0.01]、术后肠道功能恢复时间[SMD=–0.85,95%CI 为(–1.20,–0.51),P<0.000 01]和术后首次经口进食时间[MD=–0.90,95%CI 为(–1.27,–0.52),P<0.000 01]早,术后住院时间短[MD=–4.03,95%CI 为(–5.62,–2.44),P<0.000 01],术后总体并发症发生率[OR=0.49,95%CI 为(0.38,0.64),P<0.000 01]、手术相关并发症发生率[OR=0.54,95%CI 为(0.39,0.74),P=0.000 1]、切口并发症发生率[OR=0.42,95% CI 为(0.22,0.81),P=0.010]及呼吸系统并发症发生率[OR=0.60,95% CI 为(0.38,0.95),P=0.03]均较低,但 2 组患者的手术时间[MD=8.36,95%CI 为(–10.97,27.69),P=0.40]和术后吻合口漏发生率[OR=0.60,95%CI 为(0.27,1.31),P=0.20]比较差异均无统计学意义。 结论 对老年胃癌患者,LAG 与 COG 同样安全及可行,且 LAG 在减少术中出血量及保证术中淋巴结清扫数量方面具有明显优势,具有创伤小、术后住院时间短、术后总体并发症发生率低等近期疗效优势。

Objective To evaluate the safety and efficacy of laparoscopic-assisted gastrectomy (LAG) comparing with conventional open gastrectomy (COG) in elderly patients with gastric cancer. Methods Databases included PubMed, EMBASE, Web of Science, Cochrane Library, CNKI, Wanfang, and VIP were searched to collect the controlled studies about LAG versus COG for elderly patients with gastric cancer, and the searched time was from inception to May. 2017. Then meta-analysis was performed by using RevMan 5.2 software. Results Finally, ten studies included 1 522 patients were enrolled. There were 757 patients in LAG group and 765 patients in COG group. Results of meta-analysis showed that: LAG was associated with less intraoperative blood loss [MD=–121.12, 95% CI was (–179.93, –62.31), P<0.000 1], more harvested lymph nodes[MD=1.62, 95% CI was (0.60, 2.65), P=0.002], shorter time to the first ambulation [SMD=–0.94, 95%CI was (–1.46, –0.43), P=0.01], shorter the postoperative intestinal function recovery time [SMD=–0.85, 95% CI was (–1.20, –0.51), P<0.000 01], shorter the time of oral intake [MD=–0.90, 95%CIwas (–1.27, –0.52), P<0.000 01], shorter hospital stay [MD=–4.03, 95% CI was (–5.62, –2.44), P<0.000 01], lower incidences of overall postoperative complications [OR=0.49, 95% CI was (0.38, 0.64), P<0.000 01], surgical-related complications [OR=0.54, 95% CI was (0.39, 0.74), P=0.000 1], incision related complications [OR=0.42, 95% CI was (0.22, 0.81), P=0.010], and respiratory complications [OR=0.60, 95% CI was (0.38, 0.95), P=0.03], but there was no significant difference on the operative time [MD=8.36, 95% CI was (–10.97, 27.69), P=0.40] and incidence of anastomotic fistula [OR=0.60, 95%CI was (0.27, 1.31), P=0.20]. Conclusions The available evidences suggest that LAG is equally safe and feasible compared to COG. LAG has a significant advantage in reducing intraoperative blood loss and ensuring the number of lymph node dissection during surgery, with less trauma, shorter postoperative hospital stay, and overall postoperative complications rate, and other short-term efficacy advantages.

关键词: 胃癌; 老年人; 腹腔镜胃癌根治术; 开放胃癌根治术; meta 分析

Key words: gastric cancer; elderly patient; laparoscopic-assisted gastrectomy; conventional open gastrectomy; meta-analysis

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