Zhang Chun-Dong, Chen Shu-Chen, Feng Zi-Feng, Zhao Zhe-Ming, Wang Ji-Nan, Dai Dong-Qiu
Department of Gastrointestinal Surgery, the Fourth Affiliated Hospital of China Medical University, Shenyang, China.
Surg Laparosc Endosc Percutan Tech. 2013 Aug;23(4):365-77. doi: 10.1097/SLE.0b013e31828e3e6e.
To perform a meta-analysis comparing laparoscopic versus open gastrectomy (LG vs. OG) for early gastric cancer (EGC) in Asia.
PubMed, Embase, CINAHL, AMED, the Cochrane database of Systematic Reviews, the Cochrane Controlled Trials Register, and the China National Knowledge Infrastructure electronic databases were systematically searched for studies published between January 1, 1992 and July 1, 2012. A series of clinical indices, including operative time, incision length, blood loss, harvested lymph nodes, time to flatus postoperatively, time to first oral intake postoperatively, use of analgesics, complications, duration of hospital stay, recurrence, and mortality were compared using weighted mean differences (WMDs) and odds ratios (ORs).
Five randomized controlled trials and 11 case controls were included, including 1665 patients with EGC (919 LG, 746 OG). LG was associated with less trauma (incision length: WMD -12.91 cm; P<0.00001), less blood loss (WMD -121.04 mL, P<0.00001), less postoperative pain (number of times to use analgesics: WMD -1.64; P=0.001), faster bowel recovery (time to flatus: WMD -0.62 d; P=0.0001), fewer serious complications (OR 0.57; P=0.01), and shorter postoperative hospital stay (WMD -3.73 d; P=0.0007). However, LG had longer operative times (WMD 44.09 min; P<0.00001). LG also had fewer harvested lymph nodes, although this difference was not statistically significant (WMD -3.43 lymph nodes; P=0.04). There was no difference in recurrence rates (OR 0.58; P=0.33) and mortality between LG and OG.
For the treatment of EGC in Asia, LG has several advantages, including safety, less trauma, and faster recovery. Our results should be validated in western studies.
进行一项荟萃分析，比较亚洲早期胃癌（EGC）患者接受腹腔镜胃切除术（LG）与开腹胃切除术（OG）的疗效。
系统检索PubMed、Embase、CINAHL、AMED、Cochrane系统评价数据库、Cochrane对照试验注册库以及中国知网电子数据库，查找1992年1月1日至2012年7月1日期间发表的研究。使用加权均数差（WMD）和比值比（OR）比较一系列临床指标，包括手术时间、切口长度、失血量、清扫淋巴结数量、术后排气时间、术后首次进食时间、镇痛药使用情况、并发症、住院时间、复发率和死亡率。
纳入5项随机对照试验和11项病例对照研究，共1665例EGC患者（LG组919例，OG组746例）。LG具有创伤小（切口长度：WMD -12.91 cm；P<0.00001）、失血量少（WMD -121.04 mL，P<0.00001）、术后疼痛轻（镇痛药使用次数：WMD -1.64；P=0.001）、肠道恢复快（排气时间：WMD -0.62 d；P=0.0001）、严重并发症少（OR 0.57；P=0.01）及术后住院时间短（WMD -3.73 d；P=0.0007）等优点。然而，LG手术时间较长（WMD 44.09 min；P<0.00001）。LG清扫的淋巴结数量也较少，尽管差异无统计学意义（WMD -3.43枚淋巴结；P=0.04）。LG与OG的复发率（OR 0.58；P=0.33）和死亡率无差异。
对于亚洲EGC的治疗，LG具有安全性高、创伤小和恢复快等优势。我们的研究结果应在西方研究中得到验证。
