CAJ | 학술논문

目的比较全胃切除术与近端胃切除术治疗胃上部癌的效果.方法通过检索Medline、Cochrane Library及Web of Science数据库和中国期刊全文数据库、万方数据库,收集国内外1980年1月至2011年10月公开发表的有关胃上部癌手术治疗的英文及中文文献.根据所行手术不同将患者分为近端胃切除术组和全胃切除术组.应用RevMan 5.1软件进行Meta分析.二分类变量采用优势比(OR)合并值及95％可信区间(95％CI)表示.结果纳入13篇文献,共2622例胃上部癌患者,其中全胃切除术组1464例,近端胃切除术组1158例.两组患者1年生存率比较,差异无统计学意义(OR=1.23,P＞0.05)；全胃切除术组患者的3、5年生存率显著高于近端胃切除术组(OR=1.74,1.45,P＜0.05)；按TNM分期对5年生存率进行分层分析,两组TNM Ⅰ、Ⅱ、Ⅳ期患者5年生存率比较,差异无统计学意义(OR =0.94,1.31,2.03,P＞0.05)；但TNMⅢ期患者中,全胃切除术组患者5年生存率显著高于近端胃切除术组(OR=2.29,P＜0.05).全胃切除术组患者的总体复发率略低于近端胃切除术组,但差异无统计学意义(OR =0.44,P＞0.05)；其中,全胃切除术组患者的局部复发率低于近端胃切除术组(OR =0.29,P ＜0.05)；两组患者的远处复发率比较,差异无统计学意义(OR=0.60,P＞0.05).结论胃上部癌行全胃切除术的中、远期疗效均优于近端胃切除术；应按照肿瘤的分期个体化地评估手术的价值,指导手术方案的选择.
목적 비교전위절제술여근단위절제술치료위상부암적효과.방법 통과검색Medline、Cochrane Library급Web of Science수거고화중국기간전문수거고、만방수거고,수집국내외1980년1월지2011년10월공개발표적유관위상부암수술치료적영문급중문문헌.근거소행수술불동장환자분위근단위절제술조화전위절제술조.응용RevMan 5.1연건진행Meta분석.이분류변량채용우세비(OR)합병치급95％가신구간(95％CI)표시.결과 납입13편문헌,공2622례위상부암환자,기중전위절제술조1464례,근단위절제술조1158례.량조환자1년생존솔비교,차이무통계학의의(OR=1.23,P＞0.05)；전위절제술조환자적3、5년생존솔현저고우근단위절제술조(OR=1.74,1.45,P＜0.05)；안TNM분기대5년생존솔진행분층분석,량조TNM Ⅰ、Ⅱ、Ⅳ기환자5년생존솔비교,차이무통계학의의(OR =0.94,1.31,2.03,P＞0.05)；단TNMⅢ기환자중,전위절제술조환자5년생존솔현저고우근단위절제술조(OR=2.29,P＜0.05).전위절제술조환자적총체복발솔략저우근단위절제술조,단차이무통계학의의(OR =0.44,P＞0.05)；기중,전위절제술조환자적국부복발솔저우근단위절제술조(OR =0.29,P ＜0.05)；량조환자적원처복발솔비교,차이무통계학의의(OR=0.60,P＞0.05).결론 위상부암행전위절제술적중、원기료효균우우근단위절제술；응안조종류적분기개체화지평고수술적개치,지도수술방안적선택.
Objective To compare the efficacies of total gastrectomy (TG) and proximal gastrectomy (PG) for patients with upper gastric cancer.Methods Databases including Medline,Cochrane Library,Web of Science,China National Knowledge Infrastructure,Wanfang database were searched to retrieve literatures on surgical treatment of upper gastric cancer which were published from January 1980 to October 2011.According to different surgical procedures,all the patients were divided into PG group and TG group.Meta analysis were performed by RevMan 5.1.Categorical variables were presented by odds ratio (OR) and 95％ confidence interval (95％CI).Results Thirteen literatures including 2622 patients with upper gastric cancer were retrieved.There were 1464 patients in the TG group and 1158 patients in the PG group.There was no significant difference in the 1-year survival rate between the 2 groups (OR =1.23,P ＞ 0.05).The 3-and 5-year survival rates of patients in the TG group were significantly higher than those of the PG group (OR =1.74,1.45,P ＜ 0.05).There were no significant difference in the 5-year survival rates of patients in TNM Ⅰ,Ⅱ,Ⅳ stages between the 2 groups (OR =0.94,1.31,2.03,P ＞ 0.05),while the 5-year survival rate of patients in TNM Ⅲ stage of TG group was significantly higher than PG group (OR =2.29,P ＜ 0.05) The overall recurrence rate of TG group was slightly lower than that of PG group,with no significant difference OR =0.44,P ＞ 0.05).The local recurrence rate of TG group was significantly lower than that of PG group (OR =0.29,P ＜ 0.05).There was no significant difference in the distal recurrence rate between the 2 groups (OR =0.60,P ＞ 0.05).Conclusions The medium and longterm efficacies of TG are superior than that of PG.The stage of cancer should be taken into account to determine the plan of individual treatment.