中华临床医师杂志(电子版)
中華臨床醫師雜誌(電子版)
중화림상의사잡지(전자판)
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
23期
10814-10818
,共5页
于晓天%蒋超%张楷%张淼%沈正海%张云
于曉天%蔣超%張楷%張淼%瀋正海%張雲
우효천%장초%장해%장묘%침정해%장운
腹腔镜%胃肿瘤%Meta分析
腹腔鏡%胃腫瘤%Meta分析
복강경%위종류%Meta분석
Laparoscopes%Stomach neoplasms%Meta-analysis
目的:比较完全腹腔镜远端胃癌根治术(TLDG)与腹腔镜辅助远端胃癌根治术(LADG)的有效性及安全性,探讨完全腹腔镜技术在远端胃癌根治术中的应用价值。方法检索 PubMed 公开发表的完全腹腔镜与腹腔镜辅助远端胃癌根治术比较的研究文献。通过采用RevMan 5.0统计软件,合并及比较两者手术时间、淋巴结清扫数目、术中出血、术后首次排气时间、术后并发症及住院时间等指标,选择计算优势比(OR,95%的可信区间)和加权均数差(WMD,95%的可信区间)作为效应尺度来评估两种术式的安全性和有效性。结果6项研究文献被纳入本次Meta分析,其中实施完全腹腔镜远端胃癌根治术656例,腹腔镜辅助远端胃癌根治术988例,共1644例患者。本项Meta分析结果显示,与腹腔镜辅助远端胃癌根治术相比,实施完全腹腔镜远端胃癌根治术的患者术中出血少、术后首次排气时间早、住院时间短(合并WMD分别为-17.79,95%CI -32.57~-3.02,P=0.02;-0.14,95%CI -0.23~-0.06,P=0.001;-0.32,95%CI -0.53~-0.12,P=0.002),而在手术时间、淋巴结清扫数目、术后并发症的发生率方面,两种术式差异无统计学意义(合并WMD为11.19,95%CI -4.54~26.92,P=0.16;3.55,95%CI -0.18~7.28,P=0.06;合并OR为1.27,95%CI 0.86~1.88,P=0.22)。结论 TLDG是安全可行的,与传统LADG具有相似的手术疗效。然而,在术中出血、术后胃肠道功能恢复方面,TLDG 更具优势,但仍然需要开展大样本的临床对照试验来进一步验证这一结论。
目的:比較完全腹腔鏡遠耑胃癌根治術(TLDG)與腹腔鏡輔助遠耑胃癌根治術(LADG)的有效性及安全性,探討完全腹腔鏡技術在遠耑胃癌根治術中的應用價值。方法檢索 PubMed 公開髮錶的完全腹腔鏡與腹腔鏡輔助遠耑胃癌根治術比較的研究文獻。通過採用RevMan 5.0統計軟件,閤併及比較兩者手術時間、淋巴結清掃數目、術中齣血、術後首次排氣時間、術後併髮癥及住院時間等指標,選擇計算優勢比(OR,95%的可信區間)和加權均數差(WMD,95%的可信區間)作為效應呎度來評估兩種術式的安全性和有效性。結果6項研究文獻被納入本次Meta分析,其中實施完全腹腔鏡遠耑胃癌根治術656例,腹腔鏡輔助遠耑胃癌根治術988例,共1644例患者。本項Meta分析結果顯示,與腹腔鏡輔助遠耑胃癌根治術相比,實施完全腹腔鏡遠耑胃癌根治術的患者術中齣血少、術後首次排氣時間早、住院時間短(閤併WMD分彆為-17.79,95%CI -32.57~-3.02,P=0.02;-0.14,95%CI -0.23~-0.06,P=0.001;-0.32,95%CI -0.53~-0.12,P=0.002),而在手術時間、淋巴結清掃數目、術後併髮癥的髮生率方麵,兩種術式差異無統計學意義(閤併WMD為11.19,95%CI -4.54~26.92,P=0.16;3.55,95%CI -0.18~7.28,P=0.06;閤併OR為1.27,95%CI 0.86~1.88,P=0.22)。結論 TLDG是安全可行的,與傳統LADG具有相似的手術療效。然而,在術中齣血、術後胃腸道功能恢複方麵,TLDG 更具優勢,但仍然需要開展大樣本的臨床對照試驗來進一步驗證這一結論。
목적:비교완전복강경원단위암근치술(TLDG)여복강경보조원단위암근치술(LADG)적유효성급안전성,탐토완전복강경기술재원단위암근치술중적응용개치。방법검색 PubMed 공개발표적완전복강경여복강경보조원단위암근치술비교적연구문헌。통과채용RevMan 5.0통계연건,합병급비교량자수술시간、림파결청소수목、술중출혈、술후수차배기시간、술후병발증급주원시간등지표,선택계산우세비(OR,95%적가신구간)화가권균수차(WMD,95%적가신구간)작위효응척도래평고량충술식적안전성화유효성。결과6항연구문헌피납입본차Meta분석,기중실시완전복강경원단위암근치술656례,복강경보조원단위암근치술988례,공1644례환자。본항Meta분석결과현시,여복강경보조원단위암근치술상비,실시완전복강경원단위암근치술적환자술중출혈소、술후수차배기시간조、주원시간단(합병WMD분별위-17.79,95%CI -32.57~-3.02,P=0.02;-0.14,95%CI -0.23~-0.06,P=0.001;-0.32,95%CI -0.53~-0.12,P=0.002),이재수술시간、림파결청소수목、술후병발증적발생솔방면,량충술식차이무통계학의의(합병WMD위11.19,95%CI -4.54~26.92,P=0.16;3.55,95%CI -0.18~7.28,P=0.06;합병OR위1.27,95%CI 0.86~1.88,P=0.22)。결론 TLDG시안전가행적,여전통LADG구유상사적수술료효。연이,재술중출혈、술후위장도공능회복방면,TLDG 경구우세,단잉연수요개전대양본적림상대조시험래진일보험증저일결론。
Objective This study aimed to compare totally laparoscopic distal gastrectomy (TLDG) to laparoscopically assisted distal gastrectomy (LADG), then to investigate the potential advantages and application value of TLDG. Methods Studies and relevant literatures comparing TLDG to LADG were searched though PubMed. Operative time, number of retrieved lymph nodes, volume of bleeding, time to first flatus, duration of postoperative hospitalization and postoperative complications were pooled and compared using RevMan 5.0. Odds ratios (OR) and weighted mean differences (WMD) were calculated with 95%confidence intervals (CI) to evaluate the effect of TLDG. Results Six recent studies of 1644 patients were included in the meta-analysis. Compared with LADG, TLDG had advantages of less bleeding (WMD -17.79, 95% CI -32.57 to -3.02, P=0.02), shorter time to first flatus (WMD -0.14, 95% CI -0.23 to -0.06, P=0.001) and shorter postoperative hospitalization (WMD -0.32, 95% CI -0.53 to -0.12, P=0.002). Operative time, mean number of lymph nodes retrieved and postoperative complication rate were not statistically different (WMD 11.19, 95%CI -4.54 to 26.92, P=0.16;3.55, 95%CI -0.18 to 7.28, P=0.06;OR 1.27, 95%CI 0.86 to 1.88, P=0.22). Conclusions TLDG appears to have comparable results to conventional LADG in the hands of experienced surgeons. More over, TLDG has the relative benefits of surgical trauma and postoperative recovery to LADG, it has broad application value and development prospects. Large scale clinical studies are needed to conduct.