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目的评价腹腔镜手术与传统开腹手术治疗食管胃结合部腺癌(AEG)的有效性和安全性,为治疗AEG的临床方案的选择提供循证依据。方法检索PubMed、Web ofScience、中国期刊全文数据库、万方数据库及维普数据库等有关腹腔镜下AEG切除术、传统开腹AEG切除术术后疗效分析及对比的临床研究相关文献,按纳入和排除标准南2名研究者独立进行筛选并提取相关数据资料,对手术时间、术中出血量、术后并发症、淋巴结清除数目和术后住院时间等指标进行汇总分析。结果腹腔镜手术时间加权均值为182.21±42.35 min,开腹手术时间均值为140±26 min,腹腔镜手术时间长于开腹手术时间,差异有统计学意义(P<0.05)。腹腔镜手术的住院时间加权后为12.7±2.8 d,开腹手术的住院时间加权为15.0士3.0 d,差异无统计学意义。腹腔镜手术术中岀血量加权均值为96.24±68.75m1,,开腹手术为220±58mL,差异有统计学意义(P<0.05)。腹腔镜手术淋巴结清扫数目加权均值为26.34±5.79枚/例,开腹手术为28.1±1.4枚/例,差异无统计学意义。结论 AEG腹腔镜手术与开腹手术比较,术中岀血量少,手术时间显著长于传统开腹手术,说明AEG镜下手术操作较为复杂,需要较高的操作技术。
Objective To evaluate the efficacy and safety of laparoscopic surgery combined with conventional laparotomy in the treatment of esophagogastric junctional adenocarcinoma (AEG) and provide an evidence base for the selection of clinical programs for AEG. Methods The clinical data of PubMed, Web of Science, Chinese Journal Full-text Database, Wanfang Database and VIP Database were analyzed retrospectively. The related literatures about the clinical efficacy of laparoscopic AEG resection and conventional open AEG resection were compared according to inclusion and exclusion criteria Two South researchers independently screened and extracted relevant data, the operation time, intraoperative blood loss, postoperative complications, lymph node clearance and postoperative hospital stay were analyzed. Results The mean time of laparoscopic operation was 182.21 ± 42.35 min, the average time of laparotomy was 140 ± 26 min, laparoscopic operation was longer than that of laparotomy, the difference was statistically significant (P <0.05). The length of hospital stay after laparoscopic surgery was 12.7 ± 2.8 days, and the duration of laparotomy was 15.0 ± 3.0 days. The difference was not statistically significant. The laparoscopic surgery blood volume weighted mean was 96.24 ± 68.75m1, open surgery was 220 ± 58mL, the difference was statistically significant (P <0.05). The weighted average number of lymph node dissection in laparoscopic surgery was 26.34 ± 5.79 / case, and the open surgery was 28.1 ± 1.4 cases / case, the difference was not statistically significant. Conclusion AEG laparoscopic surgery compared with laparotomy, intraoperative blood loss less, the operation time was significantly longer than the traditional open surgery, AEG microscope operation is more complicated and requires higher operating skills.