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目的近年来,全腹腔镜远端胃癌根治术(totally laparoscopic distal gastrectomy,TLDG)治疗胃癌的报道日益增多,手术疗效也备受关注。本研究从循证医学角度分析TLDG治疗胃癌的近期疗效。方法检索收集截至2015-11发表的比较TLDG和腹腔镜辅助远端胃切除术(laparoscopic-assisted distal gastrectomy,LADG)治疗胃癌疗效的对比研究文献,利用RevMan 5.3软件进行Meta分析。结果共纳入18篇文献,共计3 389例胃癌患者,其中LADG组1 860例,TLDG组1 529例,均为亚洲人群。Meta分析结果显示,与LADG组相比,TLDG在手术时间、近、远端切缘距离、术后排气、进食时间、术后使用止痛药以及术后并发症上差异均无统计学意义(均P值>0.05),但是TLDG组的术中出血量较LADG组明显减少(OR=33.63,95%CI为15.87~51.39),淋巴结清除数目更多(OR=-1.96,95%CI为-3.67~-0.26),且住院时间更短(OR=0.60,95%CI为0.02~1.17)。结论 TLDG在亚洲人群中,治疗胃癌是安全有效的,具有良好的近期疗效。而对于欧美人群,TLDG是否同样具有较好的近期疗效,仍值得进一步研究证实。
Objectives In recent years, total laparoscopic distal gastric cancer (totally laparoscopic distal gastrectomy, TLDG) treatment of gastric cancer has been reported more and more, and surgery has drawn much attention. This study analyzed the short-term efficacy of TLDG in the treatment of gastric cancer from the perspective of evidence-based medicine. METHODS: A comparative study of the efficacy of TLDG and laparoscopic-assisted distal gastrectomy (LADG) in the treatment of gastric cancer published as of 2015-11 was collected and compared for Meta-analysis using RevMan 5.3 software. Results A total of 18 articles were included in the study, totaling 3 389 cases of gastric cancer, including 1 860 in the LADG group and 1 529 in the TLDG group, all of Asian population. Compared with LADG group, the results of Meta analysis showed no significant difference of TLDG in operation time, proximal and distal incision distance, postoperative exhaust, eating time, analgesic after operation and postoperative complications ( (P => 0.05). However, the intraoperative blood loss in TLDG group was significantly lower than that in LADG group (OR = 33.63, 95% CI 15.87-51.39), and the number of lymph node clearance was more (OR = -1.96, 95% 3.67 ~ -0.26), and shorter hospital stay (OR = 0.60, 95% CI 0.02 ~ 1.17). Conclusion TLDG is safe and effective in the treatment of gastric cancer in Asian population, with good short-term efficacy. For the European and American populations, whether TLDG also has good recent efficacy, is still worth further study confirmed.