兰州大学机构库 >学院待认领
全胃联合脾切除治疗进展期胃癌的系统评价
Alternative TitleMeta-Analysis of total gastrectomy splenectomy in advanced gastric cancer
李鹏
Thesis Advisor何晓东
2009-05-12
Degree Grantor兰州大学
Place of Conferral兰州
Degree Name硕士
Keyword进展期胃癌 全胃切除术 全胃联合脾脏切除术 脾切除术 系统评价 随机对照试验
Abstract目的 系统评价(Meta analysissystematic review )全胃联合脾切除与脾保留两种不同术式在治疗进展期胃癌中的有效性及安全性。 方法 计算机检索PubMed、EMBASE、Cochrane Library、中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊全文数据库并手工检索有关全胃联合脾切除(TGS)与脾保留(TG)两种不同手术方式治疗进展期胃癌的随机对照试验( RCT)文献,按照Cochrane系统评价方法对纳入研究的方法学质量(随机、双盲和对照)进行评价,用RevMan4.2.10软件进行统计分析。结合其它半随机临床对照试验文献和回顾性研究文献对其进行描述性分析。 结果 共纳入2个RCT,包括394个病例,其中TGS组194例,TG组200例,各研究基线资料均具有可比性,均报道了随机方法但未提及盲法和分配隐藏。Meta分析显示,两组的1,3,5年生存率[ OR ( 95%CI )分别为0.98 ( 0.61, 1.58 ),1.41 ( 0.95, 2.10),1.29(0.86,1.29)]和并发症发生率[OR ( 95%CI ) 1.70(0.93,3.09) ]的差异均无统计学意义;手术死亡率、淋巴结清扫数、肿瘤学方面、再手术次数、平均手术时间和平均住院时间两组均无明显差异。8篇半随机临床对照试验文献和数十篇回顾性研究文献大都证明进展期胃癌根治术中全胃联合脾切除疗效不优于保留脾脏的全胃切除术。 结论 TGS治疗进展期胃癌不改善患者术后生存率,可能轻微增加术后感染性并发症发生率,对手术死亡率无影响,因脾脏对肿瘤有免疫调节作用,因此,除非脾脏癌转移或为彻底清扫脾门和脾动脉干阳性淋巴结,应避免在进展期胃癌根治术中联合脾切除。由于纳入文献样本量较少,本结论尚需更高质量的多中心大样本的随机对照试验进一步证实。
Other AbstractObjective: To assess the efficacy and safety of total gastrectomy splenectomy(TGS)versus total gastrectomy (TG)in patients with advanced gastric carcinomas. Methods: We searched PubMed, Embase, Cochrane Library, Chinese Bio-medicine Database, China Journal Fulltext Database, Chinese Scientific Journals Fulltext Database and handsearched some related Randomized Controlled Trials about TGS and TG to cure advanced gastric carcinomas, the quality of included studies was assessed according to The Cochrane Systematic Reviews Method and statistical analysis was performed by RevMan4.2.10 software. Results: Two Randomize controlled trials involving 394 patients met the inclusion criteria. All the studies mentioned method of randomization but didn’t describe the use of blinding and allocated concealment. The baseline of the included study is comparable. The Meta-analysis showed that: there are no statistically differences between the two groups in 1,3,5-year survival rate [OR(95%CI )0.98 (0.61, 1.58 ),1.41 (0.95, 2.10),1.29(0.86,1.29) respectively] and complications [OR(95%CI)1.70(0.93,3.09)]. There are no obviously differences between the two groups in operative mortality, phymatology directions, reoperation rate, mean operation time and average duration of hospital stay. Conclusions: This study suggests TGS slightly increased infected complications and was not superior to TG on survival rate, without affecting operative mortality. So splenectomy in advanced gastric carcinomas patients who had received total gastrectomy should generally be avoided, unless cancer metastatis to spleen or in order to thoroughly clear away positive lymphoid node in hilum and arteriosus truncus of spleen. Because of literature sample size is less, they still need to be confirmed by large-sample, multicenter, randomized controlled trials.
URL查看原文
Language中文
Document Type学位论文
Identifierhttps://ir.lzu.edu.cn/handle/262010/222826
Collection学院待认领
Affiliation临床医学院
Recommended Citation
GB/T 7714
李鹏. 全胃联合脾切除治疗进展期胃癌的系统评价[D]. 兰州. 兰州大学,2009.
Files in This Item:
There are no files associated with this item.
Related Services
Recommend this item
Bookmark
Usage statistics
Export to Endnote
Altmetrics Score
Google Scholar
Similar articles in Google Scholar
[李鹏]'s Articles
Baidu academic
Similar articles in Baidu academic
[李鹏]'s Articles
Bing Scholar
Similar articles in Bing Scholar
[李鹏]'s Articles
Terms of Use
No data!
Social Bookmark/Share
No comment.
Items in the repository are protected by copyright, with all rights reserved, unless otherwise indicated.