• 中国科技论文统计源期刊（中国科技核心期刊）
  • 中国医药卫生核心期刊
  • 中国抗癌协会系列期刊
中国胸部肿瘤研究协作组（CTONG）
高级检索

微创手术与普通开胸手术治疗食管癌的疗效和安全性的Meta分析

王志强, 张建华, 王成, 李斌, 苟云久

王志强, 张建华, 王成, 李斌, 苟云久. 微创手术与普通开胸手术治疗食管癌的疗效和安全性的Meta分析[J]. 循证医学, 2013, 13(5): 300-306. DOI: 10.3969/j.issn.1671-5144.2013.05.011
引用本文: 王志强, 张建华, 王成, 李斌, 苟云久. 微创手术与普通开胸手术治疗食管癌的疗效和安全性的Meta分析[J]. 循证医学, 2013, 13(5): 300-306. DOI: 10.3969/j.issn.1671-5144.2013.05.011
shu
WANG Zhi-qiang, ZHANG Jian-hua, WANG Cheng, LI Bin, GOU Yun-jiu. Minimally Invasive Surgery Compared with Traditional Surgery for Esophageal Cancer: A Meta Analysis[J]. Journal of Evidence-Based Medicine, 2013, 13(5): 300-306. DOI: 10.3969/j.issn.1671-5144.2013.05.011
Citation: WANG Zhi-qiang, ZHANG Jian-hua, WANG Cheng, LI Bin, GOU Yun-jiu. Minimally Invasive Surgery Compared with Traditional Surgery for Esophageal Cancer: A Meta Analysis[J]. Journal of Evidence-Based Medicine, 2013, 13(5): 300-306. DOI: 10.3969/j.issn.1671-5144.2013.05.011
shu

微创手术与普通开胸手术治疗食管癌的疗效和安全性的Meta分析

  • 兰州大学第二医院胸外科, 兰州 700030

详细信息
    作者简介:

    王志强（1979-）,男,甘肃定西人,医学硕士,主治医师,主要研究方向为普胸外科疾病的微创治疗。

  • 中图分类号: R735.1

Minimally Invasive Surgery Compared with Traditional Surgery for Esophageal Cancer: A Meta Analysis

  • Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou 730030, China

HTML全文

    摘要
  • 摘要: 目的 探讨微创手术用于食管癌患者的临床疗效和安全性。 方法 计算机检索Cochrane图书馆（2012年第4期）、PubMed、EMBASE、CBM、CNKI、VIP、万方 （截至2012年12月）数据库。收集食管癌微创手术的随机对照试验,采用Cochrane系统评价的方法,提取数据并由 2 名评价者独立评价并交叉核对纳入研究的质量,对同质研究采用RevMan 5.0软件进行Meta分析。 结果 共纳入7个随机对照试验包括431例患者。Meta分析结果显示: ①微创手术与开胸手术在术后生存率、复发率和术后死亡率方面并无差异;②微创手术组的术中出血量明显低于普通开胸手术[加权均数差=-175.33 mL, 95%可信区间（-195.57,-155.09） mL];③微创手术组患者的手术时间与普通开胸手术无差异;④微创手术组患者的住院时间明显短于普通开胸手术组[加权均数差=-9.14天,95%可信区间（-16.09,-2.19）天];⑤虽然微创手术与普通开胸手术在在胸部、消化道相关并发症以及肺水肿和肺栓塞方面两组之间的差异并无统计学意义,但微创手术可以明显减少术后肺部感染、吻合口瘘以及声带麻痹的并发症,而且术后肺功能明显优于普通开胸手术组。 结论 微创手术组可以明显减少术中出血量,缩短术后住院时间,减少术后肺部感染及术后总并发症发生率,促进术后肺功能的恢复;但远期疗效仍需要大样本随机对照研究进一步探索。
    Abstract: Objectives To evaluate the clinical efficacy and safety of minimally invasive surgery for esophageal cancer. Methods We searched the electronic bibliographic databases, including The Cochrane Library, PubMed, EMBASE, CBM, CNKI, VIP and Wanfang databases to assemble the randomized controlled trials （RCTs） of minimally invasive surgery for esophageal cancer. The deadline of the retrieval time was December 2012. Data were extracted and evaluated by two reviewers independently with a designed extraction form. The RevMan 5.0 software was used for meta-analysis on homogeneous studies. Results 7 clinical trials involving 431 patients were included. The results of meta-analysis showed: ① There was no significant difference between the two groups in the respect of survival rate, recurrence rate and mortality after surgery;② Minimally invasive surgery could reduce intraoperative bloodloss[WMD=-175.33 mL, 95%CI（-195.57, -155.09） mL]; ③ There was no significant difference between the two groups in the respect of operating time; ④ Minimally invasive surgery could shorten hospital stay [WMD =-9.14 days, 95%CI（-16.09, -2.19） days]; ⑤ Minimally invasive surgery could reduce the rate of pulmonary infection, anastomotic leakage and vocal cord paralysis; And lung function in minimally invasive surgery was better than traditional thoracotomy. Conclusion Evidences showed that minimally invasive surgery could decrease intraoperative bloodloss, the time of postoperative stay, the rate of pulmonary infection, anastomotic leakage and vocal cord paralysis. Further RCT is still needed to evaluate the long-term clinical efficacy of minimally invasive surgery.
    • HTML全文
    • 参考文献(18)
  • [1] 食管手术方式的选择[J]. 河南科技大学学报（医学版）,2007,25（4）: 266.
    [2] 左颈右胸腹部正中三切口治疗胸段食管癌的临床应用[J]. 实用医学杂志,2003,19（7）: 758.
    [3] 不同术式食管癌根治术前后患者肺功能情况研究[J]. 局解手术学杂志,2009,18（2）: 96-98.
    [4] J, Venissac N, Leo F, et al. Surgical treatment of diaphragmatic eventration using video-assisted thoracic surgery: A prospective study[J]. Ann Thorac Surg, 2005,79（1）: 308-312.
    [5] S, Kawahara K, Maekawa T, et al. Minimally invasive esophagectomy for stage Ⅰ and Ⅱ esophageal cancer[J]. Ann Thorac Surg, 2005,80（6）: 2070-2075.
    [6] S, Osugi H, Higashino M, et al. Comparison of three-field esophagectomy for esophageal cancer incorporating open or thoracoscopic thoracotomy[J]. Surg Endosc, 2003,17（9）: 1445-1450.
    [7] H, Takemura M, Higashino M, et al. A comparison of video-assisted thoracoscopic oesophagectomy and radical lymph node dissection for squamous cell cancer of the oesophagus with open operation[J]. Br J Surg, 2003,90（1）: 108-113.
    [8] JPT, Green S （editors）. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated September 2008]. The Cochrane Collaboration, 2008. Available from: www.cochrane-handbook.org.
    [9] T, Otani M, Osugi H, et al. The necessity of chest physical therapy for thoracoscopic oesophagectomy[J]. J Int Med Res,2005,33（4）: 434-441.
    [10] H, Narumiya K, Eguchi R, et al. Radical surgery with mini-thoracolaparotomy for esophageal cancer[J]. Nihon Geka Gakkai Zasshi, 2002,103（4）: 348-353.
    [11] SF, Prager G, Langer FB, et al. Open versus minimally invasive esophagectomy: A single-center case controlled study[J]. Surg Endosc, 2010,24（12）: 3044-3053.
    [12] SS, van Berge Henegouwen MI, Maas KW, et al.Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: A multicentre, open-label, randomised controlled trial[J]. Lancet, 2012,379（9829）: 1887-1892.
    [13] 食管癌56例根治术疗效观察及并发症处理[J]. 中外医疗,2010,29（19）: 26-27.
    [14] 胸腔镜下食管癌手术对术后早期肺功能影响的临床研究[J]. 中国内镜杂志,2007,13（3）: 302-304.
    [15] 胸腔镜下食管癌手术对术后早期肺功能影响的临床研究[J]. 中国内镜杂志, 2010,16（12）: 1250-1252.
    [16] G, Kruuna O, Leijonmarck CE, et al. Is the learning curve for laparoscopic fundoplication determined by the teacher or the pupil?[J]. Am J Surg, 2005,189（2）: 184-189.
    [17] G,Heikkinen T,Iselius L,et al. Does training in a virtual reality simulator improve surgical performance?[J]. Surg Endosc, 2002,16（1）: 126-129.
    [18] I, Alkhawaga M, Gerdes B, et al. Training of laparoscopic skills with virtual reality simulator: A critical reappraisal of the learning curve[J]. International Cong Series, 2005,1281: 1370.
    • 相关文章
    • 施引文献
    • 资源附件(0)
计量
  • 文章访问数:  281
  • HTML全文浏览量:  2
  • PDF下载量:  556
  • 被引次数: 0
出版历程
  • 收稿日期:  2012-01-30
  • 发布日期:  2013-10-27

目录

摘要
HTML全文
    参考文献(18)
    相关文章
    施引文献
    资源附件(0)

    /

    返回文章
    返回

    版权所有 © 2024 《循证医学》杂志粤ICP备15000268号

    地址：广州市越秀区惠福西路123号 广东省人民医院惠福分院《循证医学》编辑部（510180），电话：020-83844620，邮箱：xzyxzz@163.net