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腹腔镜辅助下远端胃大部切除术治疗早期胃癌的系统评价
Alternative TitleSystematic review of laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer
陈顾委
Thesis Advisor杨克虎 ; 何晓东
2008-05-29
Degree Grantor兰州大学
Place of Conferral兰州
Degree Name硕士
Keyword胃肿瘤 腹腔镜检查 胃切除术 系统评价 Meta分析 随机对照试验
Abstract【目的】 评价腹腔镜辅助下远端胃大部切除术(laparoscopy-assisted distal gastric- tomy, LADG)治疗早期胃癌的安全性及有效性。 【方法】 我们从MEDLINE(1991-2006)、EMBASE(1991-2006)、中国生物医学数据库(the Chinese Biomedical Database CBM)(1991-2006)、CNKI(1994-2006)、VIP(1991-2006)及Cochrane图书馆(2006年第4期)检索并纳入了在1991年1月到2006年12月期间出版的腹腔镜辅助下远端胃大部切除术治疗早期胃癌的随机对照试验和半随机对照试验,并对纳入研究的方法学质量(随机方法、分配隐藏、盲法)进行评价。计量资料的用加权均数差(weighted mean difference ,WMD)计算统计量,计数资料用相对危险度(relative risk, RR)或优势比(odds radio, OR)计算统计量,各效应量均以95%可信区间(confidence intervals, CI)表示。最后用RevMan4.2.9软件进行Meta分析。 【结果】 共纳入4个随机对照试验(Randomized controlled Trials, RCTs),包括123例患者。与传统开腹手术(open distal gastrectomy, ODG)相比,LADG术后并发症少[优势比(OR)0.33 95%CI (0.14, 0.77)],特别是肺部并发症明显少于ODG[WMD 0.28 95%CI (0.08, 0.96)]。LADG术中估计出血量少[WMD -85.72 95% CI (-166.87, -4.58)],术后止痛剂的使用次数少[WMD -1.69 95%CI (-2.18, -1.21)],止痛剂使用时间短[WMD -1.68 95%CI (-2.11, -1.25)],术后第一次排气时间早[WMD -0.68 95%CI (-1.26, -0.09)];LADG术后手术应激反应轻,并且正常的Th1/Th2平衡在LADG术后受到保护。住院时间[WMD -3.18 95%CI(-9.08, 2.72)]、胃排空延迟[OR 0.71 95% CI(0.14, 3.63)]、切口和吻合口并发症、术后进食水的时间[WMD -0.97 95% CI (-2.47, 0.54)]、肿瘤复发率、转移率、死亡率和生存率方面在两组间差异无统计学意义。同时Meta分析结果析显示,LADG手术时间长于ODG,淋巴结清扫数少于ODG或与ODG相当。 【结论】 LADG是治疗早期胃癌的一种安全、可行的手术,近期效果优于ODG。它具有术后疼痛轻、出血少、并发症少、胃肠功能恢复快,免疫功能影响小等优点。远期效果和ODG相当。
Other AbstractObjective: The aim of the systematic review is to compare the safety and efficacy of laparoscope-assisted distal gastrectomy for the treatment of early gastric cancer with open distal gastrectomy. Methods: We searched articles published in MEDLINE (1991-2006), EMBASE (1991-2006), Chinese Biomedical literature Database (CBM) (1991-2006), CMKI (1994-2006), VIP (1991-2006) and The Cochrane Library (No.4, 2006). Randomized controlled Trials (RCTs) or Quasi-randomized controlled trials (CCTs) comparing LADG with ODG were included. We also evaluated the quality of included studies that involved randomization, blinding, allocation concealment. Weighted mean difference (WMD) between continuous variables was calculated. For dichotomous data, relative risk (RR) or odds radio (OR) was determined. All effect values were expressed by 95% confidence intervals (CI). Meta-analysis was performed using Revman4.2.9 software. Results: Four RCTs involving 123 patients were included. Compared with ODG, LADG was associated with less complications [odds ratio (OR) 0.33 95% confidence interval (CI) (0.14 to 0.77)], this was most significant for pulmonary complications [WMD 0.28 95% CI (0.08 to 0.96)]. Estimated blood loss [weight mean difference (WMD) -85.72 95% CI (-166.87 to -4.58)] was less, the frequency [WMD -1.69 95% CI(-2.18 to -1.21)] and duration [WMD -1.68 95%CI (-2.11 to -1.25)] of analgesics required were lower, time to postoperative first flatus [WMD -0.68 95% CI (-1.26 to -0.09)] was faster after LANG. Surgery press was less in LADG than in ODG, and the Th1/Th2 balance was preserved after LADG. There was no significant difference between two groups in duration of hospital stay [WMD -3.18 95% CI (-9.08 to 2.72)], delayed gastric emptying [OR 0.71 95% CI (0.14 to 3.63)], wound and anastomosis complications and time to start first oral intake [WMD -0.97 95% CI (-2.47 to 0.54)]. There was also no statistical difference in disease recurrence rate, metastasis rate, death rate and survival rate. At the same time, the result showed that the operation time was significantly longer in LADG. The mean number of harvested lymph nodes was less or equal to ODG. Conclusion: Laparoscope-assisted radical subtotal gastrectomy for distal gastric cancer is a safe and feasible oncologic procedure with better short-term results and similar long-term results compared with ODG. Additional benefits for the LADG were reduced slighter pain,less estimated blood loss, less postoperative...
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Language中文
Document Type学位论文
Identifierhttps://ir.lzu.edu.cn/handle/262010/223551
Collection学院待认领
Affiliation临床医学院
Recommended Citation
GB/T 7714
陈顾委. 腹腔镜辅助下远端胃大部切除术治疗早期胃癌的系统评价[D]. 兰州. 兰州大学,2008.
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