CAJ | 학술논문

目的通过腹腔镜辅助远端胃癌根治术(LADG)与开腹远端胃癌根治术(ODG)比较研究文献的荟萃分析,评估当前LADG手术的安全性和肿瘤治疗效果.方法检索1995年1月至2012年10月Pubmed、Cochrane library、Web of Science和Biosis Previews数据库有关LADG和ODG的对比性研究文献.对其中的手术时间、术中出血量、淋巴结清扫数目、近端及远端切缘距离、术后肛门排气时间、术后进食时间、术后住院时间、术后并发症及5年总生存率等数据进行荟萃分析.数据分析使用RevMan 5.1软件.结果共16篇文献纳入本研究,其中随机对照研究4篇,观察性研究12篇.纳入病例2854例,其中LADG组1441例,ODG组1413例.在近期手术结果上,除手术时间较长外[加权均数差(WMD)=49.09 min,P＜0.01],LADG组具有更少的术中出血量(WMD=-118.99 ml,P＜0.01),更快的肛门排气(WMD=-0.58 d,P＜0.01)和进食时间(WMD=-0.61 d,P＜0.01),更短的术后住院时间(WMD=-2.48 d,P＜0.01)及更少的术后并发症率[相对危险度(RR)=0.62,P＜0.01].在肿瘤根治效果上,LADG组和ODG组远端切缘距离差异无统计学意义(WMD=-0.01 cm,P=0.94),但LADG组的淋巴结清扫数目少于ODG组(WMD=-2.17,P =0.05),近端切缘距离短于ODG组(WMD=-0.83 cm,P＜0.01).但以近5年或LADG病例数＞50例的文献行亚组分析显示两组间淋巴结清扫数目差异均无统计学意义(均P ＞0.05).此外,对远期随访结果的荟萃分析也表明两组间5年总生存率差异无统计学意义(RR=1.02,P=0.52).结论 LADG手术安全可行,具有术中出血少、术后恢复快和并发症少等优点,并有望达到与开腹手术相同的肿瘤治疗效果.
목적 통과복강경보조원단위암근치술(LADG)여개복원단위암근치술(ODG)비교연구문헌적회췌분석,평고당전LADG수술적안전성화종류치료효과.방법 검색1995년1월지2012년10월Pubmed、Cochrane library、Web of Science화Biosis Previews수거고유관LADG화ODG적대비성연구문헌.대기중적수술시간、술중출혈량、림파결청소수목、근단급원단절연거리、술후항문배기시간、술후진식시간、술후주원시간、술후병발증급5년총생존솔등수거진행회췌분석.수거분석사용RevMan 5.1연건.결과 공16편문헌납입본연구,기중수궤대조연구4편,관찰성연구12편.납입병례2854례,기중LADG조1441례,ODG조1413례.재근기수술결과상,제수술시간교장외[가권균수차(WMD)=49.09 min,P＜0.01],LADG조구유경소적술중출혈량(WMD=-118.99 ml,P＜0.01),경쾌적항문배기(WMD=-0.58 d,P＜0.01)화진식시간(WMD=-0.61 d,P＜0.01),경단적술후주원시간(WMD=-2.48 d,P＜0.01)급경소적술후병발증솔[상대위험도(RR)=0.62,P＜0.01].재종류근치효과상,LADG조화ODG조원단절연거리차이무통계학의의(WMD=-0.01 cm,P=0.94),단LADG조적림파결청소수목소우ODG조(WMD=-2.17,P =0.05),근단절연거리단우ODG조(WMD=-0.83 cm,P＜0.01).단이근5년혹LADG병례수＞50례적문헌행아조분석현시량조간림파결청소수목차이균무통계학의의(균P ＞0.05).차외,대원기수방결과적회췌분석야표명량조간5년총생존솔차이무통계학의의(RR=1.02,P=0.52).결론 LADG수술안전가행,구유술중출혈소、술후회복쾌화병발증소등우점,병유망체도여개복수술상동적종류치료효과.
Objective To evaluate the safety and cfficacy of laparoscopic-assisted distal gastrectomy (LADG) for gastric cancer through a meta-analysis of LADG versus open distal gastrectomy (ODG).Methods Comparative studies of LADG and ODG wer collected from Pubmed,Cochrane library,Web of Science and Biosis Previews Databases between January 1995 and October 2012.The data of operative duration,blood loss volume,number of harvested lymph node,proximal and distal resection margins,time to flatus,time to first oral intake,postoperative hospital stay,postoperative morbidity and 5-year survival rate were analyzed.And statistical analysis was performed with RevMan 5.1 software.Results A total of 16 articles were analyzed.There were 4 randomized controlled trials and 12 retrospective observational reports.Among a total of 2854 patients with gastric cancer,1441 LADG and 1413 ODG subjects wereincluded.Compared with ODG,LADG resulted in significantly prolonged operative duration (weighted mean difference (WMD) =49.09 min,P ＜ 0.01),less blood loss volume (WMD =-118.99 ml,P ＜ 0.01),less time to flatus (WMD =-0.58 d,P ＜ 0.01) and oral intake (WMD =-0.61 d,P ＜ 0.01),shortened postoperative hospital stay (WMD =-2.48 d,P ＜ 0.01) and less postoperative morbidity (relative risk (RR) =0.62,P ＜ 0.01).Distal resection margin did not differ significantly between LADG and ODG (WMD =-0.01 cm,P =0.94) while proximal resection margin was significantly shorter in the LADG group (WMD =-0.83 cm,P ＜ 0.01).The number of harvested lymph node was significantly lesser in the LADG group than that in ODG group (WMD =-2.17,P =0.05).However,no significant difference existed when only analyzing the papers published over the last 5 years or having over 50 LADG cases (all P ＞ 0.05).Furthermore,the 5-year survival rate did not differ significantly between two groups (RR =1.02,P =0.52).Conclusion As a safe and practical procedure with less blood loss volume,fewer overall complications and a quicker recovery,LADG may offer satisfactory long-term outcomes comparable to those of conventional open surgery.