CAJ | 학술논문

目的评价胃癌根治术腹主动脉旁淋巴结清扫的安全性与有效性.方法 2位评价者制定检索策略,利用PubMed和Medline等数据库检索胃癌手术腹主动脉旁淋巴结清扫的随机对照研究,运用固定效应模型与随机效应模型对术中腹主动脉旁淋巴结清扫与否的两组胃癌患者手术的安全性与有效性进行Meta分析.结果符合入选标准的随机对照临床试验7项共计胃癌根治术患者1446例.与非腹主动脉旁淋巴结清扫组比较,腹主动脉旁淋巴结清扫组患者术后并发症总发生率升高(RR 1.34,95% CI 1.03～1.75,P=0.03);术后出现淋巴瘘和严重腹泻者增多(RR分别为16.23和9.56,95% CI分别为1.99～131.98和1.70～53.67);而术后吻合口瘘、胰瘘、腹腔脓肿、肠梗阻、出血和伤口感染等发生率未见明显升高.腹主动脉旁淋巴结清扫组术中出血量及输血人数比例增加(WMD 202.95,95% CI 116.80～289.10;RR 1.93,95% CI 1.20～3.10;均P<0.05),但手术时间、平均输血量、平均术后住院天数、再次手术率、术后复发率和5年生存率等与D_2/D_3术式相近.结论腹主动脉旁淋巴结清扫术后并发症总发生率升高,并不能降低术后复发率、提高生存率,其临床疗效尚有待更严格的、多中心的、具有长期随访的大宗病例研究来证实.
목적 평개위암근치술복주동맥방림파결청소적안전성여유효성.방법 2위평개자제정검색책략,이용PubMed화Medline등수거고검색위암수술복주동맥방림파결청소적수궤대조연구,운용고정효응모형여수궤효응모형대술중복주동맥방림파결청소여부적량조위암환자수술적안전성여유효성진행Meta분석.결과 부합입선표준적수궤대조림상시험7항공계위암근치술환자1446례.여비복주동맥방림파결청소조비교,복주동맥방림파결청소조환자술후병발증총발생솔승고(RR 1.34,95% CI 1.03～1.75,P=0.03);술후출현림파루화엄중복사자증다(RR분별위16.23화9.56,95% CI분별위1.99～131.98화1.70～53.67);이술후문합구루、이루、복강농종、장경조、출혈화상구감염등발생솔미견명현승고.복주동맥방림파결청소조술중출혈량급수혈인수비례증가(WMD 202.95,95% CI 116.80～289.10;RR 1.93,95% CI 1.20～3.10;균P<0.05),단수술시간、평균수혈량、평균술후주원천수、재차수술솔、술후복발솔화5년생존솔등여D_2/D_3술식상근.결론 복주동맥방림파결청소술후병발증총발생솔승고,병불능강저술후복발솔、제고생존솔,기림상료효상유대경엄격적、다중심적、구유장기수방적대종병례연구래증실.
Objective To evaluate the safety and efficacy of paraaortic lymphadenectomy in gastric cancer with meta-analysis. Methods Randomized controlled trial comparing D_2/D_3 and D_2/D_3 plus paraaortic lymphadenectomy in gastric cancer were identified by two investigators after search strategy was established. Seven randomized controlled trials with 1446 cases were included in this meta-analysis.Fixed effect model or random model was separately used to evaluate the safety and efficacy of paraaortic lymphadenectomy in gastric cancer. Results Total complication rate in the D_2/D_3 plus paraaortic lymphadenectomy group was significantly higher than that in the D_2/D_3 group(RR 1.34,95% CI 1.03-1.75,P=0.03), while surgery associated complication between the two groups was almost the same.Lymphorrhea and severe diarrhea was more common in the D_2/D_3 plus paraaortic lymphadenectomy (RR 16.23 and 9.56, 95% CI 1.99-131.98 and 1.70-53.67, respectively). Anastomotic leak, pancreatic fistula,abdominal abscess, ileus, postoperative bleeding and wound infection were similar. There were no advantages in operating time, amount of blood transfusion, in-hospital stay, reoperation, recurrence and 5-year survival favoring the paraaortic lymphadenectomy group except intra-operative blood loss and rate of blood transfusion(WMD 202.95, 95% CI 116.80-289.10; RR 1.93, 95% CI 1.20-3.10). Conclusions Paraaortic lymphadenectomy is associated with increased total complication without altering postoperative recurrence and survival. Strict large-scale multicenter controlled trials with long-term follow-up are required.