中国实用外科杂志

中国实用外科杂志

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腹腔镜与开放全胃切除D2胃癌根治术行脾门淋巴结清扫疗效对照Meta分析

胡    林，李昌荣，李伟峰，李红浪   

  1. 南昌大学第二附属医院胃肠外科，江西南昌330006
  • 出版日期:2015-10-01 发布日期:2015-10-09

  • Online:2015-10-01 Published:2015-10-09

摘要：

目的    评价开放与腹腔镜全胃切除D2胃癌根治术行脾门淋巴结清扫的优劣。方法    检索2000年1月至2014年10月公开发表的对比腹腔镜脾门淋巴结清扫和开放脾门淋巴结清扫在全胃癌根治术中应用的文献。按纳入标准筛选后进行质量评分，提取临床效应指标，采用RevMan5.2软件对所纳入的数据进行Meta分析。
结果    共有6项研究纳入分析。Meta分析结果显示：与开放组相比，腹腔镜脾门淋巴结清扫手术失血量少［加权均数差（weighted mean difference，WMD）=135.62，95%CI 61.04~ 210.20，P<0.05］、术后排气时间早（WMD=0.73，95%CI 0.27~ 1.20，P<0.05）、恢复饮食快（WMD=1.05，95%CI 0.88~ 1.22，P<0.05）、住院时间短（WMD=4.16，95%CI 2.45~ 5.88，P<0.05）、淋巴结清扫数量多（WMD= -2.11，95%CI -3.31~-0.90，P<0.05）、但手术时间较长（WMD= -34.62，95%CI -54.71~ -12.53，P=0.002） 结论    与开放手术相比，腹腔镜全胃切除并行脾门淋巴结清扫具有术中出血少、恢复快等优势。

关键词: 胃肿瘤, 腹腔镜, 胃切除术, 淋巴结清扫, Meta分析

Abstract:

Comparison of the short-term outcome of splenic hilar lymph node dissection in laparoscopic and open total gastrectomy D2 radical gastrectomy ：A Meta analysis        HU Lin，LI Chang-rong，LI Wei-feng，et al. Department of Gastrointestinal Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang 330006，China
Corresponding author: LI Hong-lang, E-mail：lihonglang6802@163.com
Abstract    Objective    To evaluate the safety and feasibility of laparoscopic spleen-preserving splenic hilar lymphadenectomy in radical gastrectomy. Methods    The literatures before October, 2014 were searched extensively to retrieve the comparative studies of laparoscopic and open spleen-preserving splenic hilar lymphadenectomy in radical gastrectomy with a relevance of study goal．The inclusion and exclusion criteria were formulated．After a quality evaluation, the data were extracted．The Cochrane Collaboration RevMan 5.2 version software was used for Meta-analysis．Results    A total of six studies met the inclusion criteria for Meta-analysis．Compared with the open surgery, laparoscopic spleen-preserving splenic hilar lymphadenectomy experienced less blood loss（WMD=135.62，95%CI 61.04-210.20，P<0.05), earlier time to flatus（WMD=0.73，95%CI 0.27-1.20，P<0.05）, shorter resume soft diet time（WMD=1.05，95%CI 0.88-1.22，P<0.05）, shorter hospital stay（WMD=4.16, 95%CI 2.45-5.88，P<0.05), more dissected lymph nodes（WND= -2.11, 95%CI -3.31--0.90，P<0.05), longer operative time（WMD=-34.62, 95%CI -54.71--12.53，P=0.002). Conclusion    Compared with open operation, laparoscopic total gastrectomy concurrent splenic hilar lymphnode dissection has the advantages of less blood loss and quick recovery.

Key words: gastric tumor, laparoscopy, gastrectomy, lymph node excision, Meta- analysis