中国普外基础与临床杂志

中国普外基础与临床杂志

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对比分析全腹腔镜与腹腔镜辅助全胃切除术近期疗效的 meta 分析

杜恒锐 , 王振江 , 任彦先 , 展昊 , 张耕源 , 焦作义

兰州大学第二医院普外一科（兰州  730030）

收稿日期: 2018-07-25;  修回日期:2018-09-30; 

基金项目: 国家自然科学基金资助项目（项目编号：31670847）

通讯作者: 焦作义, Email: jiaozx@lzu.edu.cn

Short-term efficacy of totally laparoscopic and laparoscopic assisted total gastrectomy: a meta-analysis

DU Hengrui , WANG Zhenjiang , REN Yanxian , ZHAN Hao , ZHANG Gengyuan , JIAO Zuoyi

The First Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, P. R. China

Corresponding Author: JIAO Zuoyi, Email: jiaozx@lzu.edu.cn

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目的 对比分析全腹腔镜全胃切除术（TLTG）与腹腔镜辅助全胃切除术（LATG）两种术式在治疗可切除胃癌方面的近期疗效。 方法 计算机检索 EMbase、PubMed、The Cochrane Library、Web of Science、中国生物医学文献数据库、中国知网及万方数据库，按文献的纳入与排除标准筛选出符合要求的对比研究文献，提取相关数据并进行文献评估，应用 Revman 5.3 软件进行 meta 分析。 结果 共纳入 11 篇文献（6 篇中文文献，5 篇英文文献），包括 1 491 例临床诊断明确的胃癌患者。meta 分析结果显示，与 LATG 组相比，TLTG 组在治疗胃癌方面术中出血量少 ［MD=–17.59，95%CI（–30.81，–4.37），P=0.009］、切口长度短 ［MD=–4.50，95%CI（–4.92，–4.09），P<0.000 01］、术后首次肛门排气时间早 ［MD=–0.16，95%CI（–0.28，–0.04），P=0.007］、术后首次进流食时间早 ［MD=–0.47，95%CI（–0.86，–0.08），P=0.02］、术后住院时间短 ［MD=–0.59，95%CI（–0.94，–0.24），P=0.000 9］、术后第 1 天和第 3 天疼痛视觉模拟评分均低 ［术后第 1 天：MD=–3.10，95%CI（–3.48，–2.72），P<0.000 01；术后第 3 天MD=–2.30，95%CI（–2.57，–2.03），P<0.000 01］，而 2 组在手术时间、近端切缘距离、远端切缘距离、淋巴结清扫数目及术后不良反应方面差异均无统计学意义（P>0.05）。并发症亚组分析结果显示，TLTG 组与 LATG 组在吻合口漏、吻合口出血及吻合口狭窄方面比较差异均无统计学意义（P>0.05）。 结论 TLTG 在治疗可切除胃癌方面具有出血少、切口短、通气及进食时间早、术后住院时间短及术后疼痛轻的优点，但因纳入研究的数量和质量限制，以上结论仍需开展更多高质量的研究予以验证。

Objective To compare short-term effects of totally laparoscopic total gastrectomy (TLTG) and laparoscopic assisted total gastrectomy (TATG) in treatment of resectable gastric cancer. Methods The EMbase, PubMed, The Cochrane Library, Web of Science, CBM, CNKI, and WanFang Data databases were searched by computer. According to the inclusion and exclusion criteria of the literatures, the comparative research literatures were selected. The relevant data were extracted and the literature evaluation was applied. The Revman 5.3 software was applied for the meta-analysis. Results A total of 11 articles (6 Chinese literatures, 5 English literatures) were included, including 1 491 patients clinically diagnosed with the gastric cancer. The results of meta-analysis showed: compared with the LATG group, the TLTG group had the less intraoperative blood loss ［MD=–17.59, 95% CI (–30.81, –4.37), P=0.009］, shorter incision length ［MD=–4.50, 95% CI (–4.92, –4.09), P<0.000 01］, and earlier first anal exhaust time ［MD=–0.16, 95% CI (–0.28, –0.04), P=0.007］in the treatment of gastric cancer; Besides, the first time of postoperative fluid intake of the TLTG group was earlier ［MD=–0.47, 95% CI (–0.86, –0.08), P=0.02］ and the postoperative hospital stay of the TLTG group was shorter ［MD=–0.59, 95% CI (–0.94, –0.24), P=0.000 9］; In the TLTG group, the VAS score was lower on the first postoperative day ［MD=–3.10, 95% CI (–3.48, –2.72), P<0.000 01］ and on the third postoperative day ［MD=–2.30, 95% CI (–2.57, –2.03), P<0.000 01］. There were no significant differences in the operation time, proximal margin distance, distal margin distance, lymph node dissection, and postoperative adverse reactions between the two groups (P>0.05). The subgroup analysis of the postoperative adverse reactions showed that there were no significant differences in the anastomotic stricture, anastomotic leakage, and anastomotic bleeding (P>0.05). Conclusions TLTG has some advantages of less bleeding, shorter incision, earlier ventilation and feeding, shorter postoperative hospital stay, and light postoperative pain in treatment of resectable gastric cancer. However, due to quantitative and qualitative limitations of included studies, above conclusions still need to be carried out more and high quality researches are validated.

关键词: 胃癌; 腹腔镜全胃切除术; meta 分析

Key words: gastric cancer; laparoscopic total gastrectomy; meta-analysis

引用本文： 杜恒锐, 王振江, 任彦先, 展昊, 张耕源, 焦作义. 对比分析全腹腔镜与腹腔镜辅助全胃切除术近期疗效的 meta 分析. 中国普外基础与临床杂志, 2018, 25(11): 1343-1352. doi: 10.7507/1007-9424.201807074 复制

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