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目的系统评价腹腔镜切除术治疗胃间质瘤的疗效和安全性。方法按Cochrane系统评价方法,计算机检索PubMed、EMbase、Wiley Online Library、MEDLINE、CNKI、VIP、CBM数据库,检索时间从建库截止2010年12月,并手工检索相关文献,查找腹腔镜与开腹术比较治疗胃间质瘤的随机和非随机对照试验。由2位研究者按照纳入排除标准筛选文献、评价质量并提取资料后,采用RevMan 5.0软件进行Meta分析。结果纳入4个半随机对照试验和8个同期的临床对照试验,共496例患者。Meta分析结果显示:与开腹术相比,腹腔镜手术住院时间短[MD=–2.81,95%CI(–4.51,–1.11)],术后复发及转移发生率低[OR=0.36,95%CI(0.13,1.01)]。但两组在手术时间、出血量、首次排气和进食时间、并发症方面,其差异均无统计学意义(P>0.05)。结论现有研究显示,腹腔镜手术治疗胃间质瘤在减少住院时间、降低复发和转移发生率方面优于传统开腹手术。由于纳入研究方法学质量较低且数量少,期待更多高质量的随机对照试验以提供更高质量的证据。
Objective To evaluate the efficacy and safety of laparoscopic resection of gastric stromal tumors. Methods According to the Cochrane systematic review method, PubMed, EMbase, Wiley Online Library, MEDLINE, CNKI, VIP and CBM databases were searched by computer. The search time was from December, 2010 to December, Randomized and non-randomized controlled trials comparing gastric stromal tumors. Two researchers screened the literature according to the exclusion criteria, evaluated the quality and extracted the data. Meta-analysis was performed using RevMan 5.0 software. Results A total of 496 patients were enrolled in four randomized controlled trials and eight concurrent controlled trials. Meta-analysis showed that laparoscopic surgery had a shorter length of stay (MD = -2.81,95% CI -4.51, -1.11) and a lower incidence of postoperative recurrence and metastasis compared with open surgery (OR = 0.36, 95 % CI (0.13, 1.01)]. However, there was no significant difference between the two groups in the operation time, the amount of bleeding, the time of the first excretion, the time of eating and the complications (P> 0.05). Conclusion The current research shows that laparoscopic treatment of gastric stromal tumors in reducing hospital stay, reduce the incidence of recurrence and metastasis than the traditional open surgery. Due to the low quality and small number of included research methodology, more high-quality randomized controlled trials are expected to provide higher quality evidence.