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目的评价开放与腹腔镜全胃切除D2胃癌根治术行脾门淋巴结清扫的优劣。方法检索2000年1月至2014年10月公开发表的对比腹腔镜脾门淋巴结清扫和开放脾门淋巴结清扫在全胃癌根治术中应用的文献。按纳入标准筛选后进行质量评分,提取临床效应指标,采用Rev Man5.2软件对所纳入的数据进行Meta分析。结果共有6项研究纳入分析。Meta分析结果显示:与开放组相比,腹腔镜脾门淋巴结清扫手术失血量少[加权均数差(weighted mean difference,WMD)=135.62,95%CI 61.04~210.20,P<0.05]、术后排气时间早(WMD=0.73,95%CI 0.27~1.20,P<0.05)、恢复饮食快(WMD=1.05,95%CI 0.88~1.22,P<0.05)、住院时间短(WMD=4.16,95%CI2.45~5.88,P<0.05)、淋巴结清扫数量多(WMD=-2.11,95%CI-3.31~-0.90,P<0.05)、但手术时间较长(WMD=-34.62,95%CI-54.71~-12.53,P=0.002)结论与开放手术相比,腹腔镜全胃切除并行脾门淋巴结清扫具有术中出血少、恢复快等优势。
Objective To evaluate the advantages and disadvantages of open and laparoscopic radical gastrectomy for D2 gastric cancer undergoing radical lymphadenectomy. Methods The literature published from January 2000 to October 2014 on the comparison of laparoscopic splenic lymph node dissection and open splenic lymph node dissection in radical gastrectomy was searched. According to the inclusion criteria, the quality score was screened and the clinical effect index was extracted. The included data were analyzed by Meta-analysis using RevMan5.2 software. Results A total of six studies were included in the analysis. Meta-analysis showed that compared with the open group, laparoscopic splenic lymph node dissection less blood loss (weighted mean difference (WMD) = 135.62, 95% CI 61.04 to 210.20, P <0.05], postoperative (WMD = 1.05, 95% CI 0.88-1.22, P <0.05), short hospital stay (WMD = 4.16, 95% CI 0.27 to 1.20, P < % CI 2.45-5.88, P <0.05). The number of lymph node dissection was significantly higher (WMD = -2.11,95% CI -3.31-0.90, P <0.05), but the operation time was longer (WMD = -34.62, 95% CI -54.71 ~ -12.53, P = 0.002) Conclusions Compared with open surgery, laparoscopic total gastrectomy combined with splenic lymph node dissection has the advantages of less intraoperative bleeding and faster recovery.