贲门癌手术不同路径疗效的Meta分析-东南大学学报医学版

贲门癌手术不同路径疗效的Meta分析

单位：1. 郑州大学第二附属医院胸外科, 河南郑州 450014;
2. 郑州大学第二附属医院病理科, 河南郑州 450014

分类号：R735

出版年·卷·期（页码）：2016·35·第六期（866-874）

摘要：

目的：系统评价贲门癌手术经腹与经胸路径的安全性及有效性。方法：检索PubMed、EMBASE、CBM、中国知网、万方、维普数据库，收集有关贲门癌不同术式的随机对照研究或病例对照研究，利用Stata 12.0软件进行Meta分析。结果：最终19篇文献共4 192例患者纳入研究，其中试验组（经腹路径）2 357例，对照组（经胸路径）1 835例。Meta分析结果显示，与对照组相比，实验组手术时间短（WMD=-23.29，95%CI=-39.66~-6.93，P=0.005）、术中出血量少（WMD=-63.71，95%CI=-115.68~-11.74，P=0.02）、淋巴结清扫数目多（WMD=2.63，95%CI=0.98~4.27，P=0.002）、下切缘肿瘤残留率低（OR=0.36，95%CI=0.15~0.88，P=0.03）、术后住院时间短（WMD=-3.16，95%CI=-3.88~-2.43，P<0.000 01）、术后并发症少（OR=0.45，95%CI=0.25~0.80，P=0.007），但上切缘肿瘤残留率高（OR=4.23，95%CI=2.19~8.19，P<0.000 1）。二者在5年生存率方面差异无统计学意义（OR=1.10，95%CI=0.83~1.48，P=0.50）。结论：贲门癌手术经腹路径适用范围广，具有手术时间短、术中失血量少、淋巴结清扫数目多、下切缘肿瘤残留率低、术后恢复快、并发症少等优点，而经胸路径更适合于肿瘤部位靠上的患者。

Objective: To systematically evaluate the safety and efficiency of transabdominal and transthoracic approaches for surgical treatment of cardiac carcinoma. Methods: PubMed, EMBASE, CBM, CNKI, Wan Fang and VIP Database were searched from the date of their establishment to February 2016 to collect the randomized controlled trials and case-control study. Then Meta-analysis was conducted using Stata 12.0 software. Results: Nineteen studies including 4 192 patients were finally selected, in which the transabdominal group had 2 357 cases and the transthoracic group had 1 835 cases. The Meta-analysis results showed that the transabdominal group have advantage of the operation time(WMD=-23.29,95%CI=-39.66--6.93,P=0.005), the bleeding amount in operation(WMD=-63.71,95%CI=-115.68--11.74,P=0.02), the number of lymph node dissections(WMD=2.63,95%CI=0.98-4.27,P=0.002), the lower incisal margin positive rate(OR=0.36,95%CI=0.15-0.88,P=0.03), the postoperative hospital stay(WMD=-3.16,95%CI=-3.88--2.43,P<0.000 01), the postoperative complications(OR=0.45,95%CI=0.25-0.80,P=0.007), but the upper incisal margin positive rate(OR=4.23,95%CI=2.19-8.19,P<0.000 1). While there was no significant difference in the 5-year survival rate(OR=1.10,95%CI=0.83-1.48,P=0.50). Conclusion: The transabdominal approach has the advantages of wide application range, short operation time, less bleeding amount in operation, more number of lymph node dissections, low upper incisal margin positive rate, rapid postoperative recovery and few postoperative complications. While the transthoracic approach is more suitable for the patients whose tumor site near the gastroesophageal.

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