CAJ | 학술논문

背景与目的:随着腹腔镜的应用,早期胃癌的腹腔镜手术已逐渐在临床推广,而腹腔镜辅助的远端胃切除术的临床疗效和安全性尚有待探索.本研究比较和评价腹腔镜辅助远端胃切除术与传统开腹手术治疗早期胃癌的临床疗效和安全性.方法:以行腹腔镜手术或开腹手术治疗的早期胃癌患者为研究对象,从MEDLINE、EMBASE、中国生物医学数据库(CBM)及Cochrane试验注册中心检索近10年来发表的临床随机对照研究文献,评估文献质量并提取数据资料,应用Meta分析专用软件包RevMan(4.2.2版)进行统计分析.结果:经筛选有6个随机对照试验(randomized controlled trials,RCT)共218例患者纳入系统评价.与开腹手术组相比,腹腔镜手术组的出血量少[加权均数差(weighted mean difference,WMD):-121.86;95%可信区间(confidence interval,95% CI):-145.61,-98.11;P<0.001]、术后肛门排气时间短(WMD:-0.95;95%CI:-1.09,-0.81;P<0.001)、住院时间短(WMD:-2.27;95%CI:-3.47,-1.06;P<0.001),但手术时间长(WMD:58.71;95%CI:52.69,64.74;P<0.001)、清扫淋巴结数量少(WMD:-3.64;95%CI:-5.80,-1.47;P=0.001);腹腔镜手术组术后并发症发生率与开腹手术组之间的差异无统计学意义(OR:0.57;95%CI:0.31,1.03:P=0.06).结论:腹腔镜手术是安全的,其治疗的患者术后早期恢复情况优于开腹手术治疗者,但远期效果尚需进一步研究.
배경여목적:수착복강경적응용,조기위암적복강경수술이축점재림상추엄,이복강경보조적원단위절제술적림상료효화안전성상유대탐색.본연구비교화평개복강경보조원단위절제술여전통개복수술치료조기위암적림상료효화안전성.방법:이행복강경수술혹개복수술치료적조기위암환자위연구대상,종MEDLINE、EMBASE、중국생물의학수거고(CBM)급Cochrane시험주책중심검색근10년래발표적림상수궤대조연구문헌,평고문헌질량병제취수거자료,응용Meta분석전용연건포RevMan(4.2.2판)진행통계분석.결과:경사선유6개수궤대조시험(randomized controlled trials,RCT)공218례환자납입계통평개.여개복수술조상비,복강경수술조적출혈량소[가권균수차(weighted mean difference,WMD):-121.86;95%가신구간(confidence interval,95% CI):-145.61,-98.11;P<0.001]、술후항문배기시간단(WMD:-0.95;95%CI:-1.09,-0.81;P<0.001)、주원시간단(WMD:-2.27;95%CI:-3.47,-1.06;P<0.001),단수술시간장(WMD:58.71;95%CI:52.69,64.74;P<0.001)、청소림파결수량소(WMD:-3.64;95%CI:-5.80,-1.47;P=0.001);복강경수술조술후병발증발생솔여개복수술조지간적차이무통계학의의(OR:0.57;95%CI:0.31,1.03:P=0.06).결론:복강경수술시안전적,기치료적환자술후조기회복정황우우개복수술치료자,단원기효과상수진일보연구.
Background and Objective: With the application of laparoscopy,laparoscopic gastrectomy for the treatment of patients with early gastric cancer has been performed,but the safety and effectiveness of this method needs to be explored.This study evaluated the safety and effectiveness of laparoscopy-assisted and conventional open distal gastrectomy for patients with early gastric cancer.Methods: A search of MEDLINE,EMBASE,the Chinese Biomedical Database(CBM),and Cochrane Central Register of Controlled Trials(CENTRAL)identified all the randomized clinical trials that compared laparoscopy-assisted gastrectomy with open distal gastrectomy for patients with early gastric cancer published in the last 10 years.Quality assessment was done on each trial and relevant data were extracted from qualified trials.Meta-analysis was performed using RevMan 4.2.2 software(Cochrane).Results: Six randomized controlled trials(RCTs)involving 218patients were included.Comparing laparoscopic resection with open resection,results showed less estimated blood loss[WMD(weighted mean difference):-121.86; 95% CI(confidence interval):-145.61,-98.11 ;P<0.001],earlier postoperative first flatus(WMD:-0.95; 95 % CI:-1.09,-0.81 ; P<0.001),and shorter durations of hospital stays(WMD:-2.27;95% CI:-3.47,-1.06; P=0.0002),but longer surgery times(WMD:58.71 ; 95 % CI: 52.69,64.74; P<0.001)and fewer lymph nodes dissected(WMD:-3.64; 95% CI:-5.80,-1.47; P=0.001).There was no significant difference between the two groups in postoperative complications[OR(odds ratio): 0.57; 95% CI: 0.31,1.03; P=0.06].Conclusion: The short-term outcome of laparoscopy-assisted distal gastrectomy for patients with early gastric cancer is superior to the open procedure,but its long-term outcome should be proven by further outcomes of RCTs.