胃癌根治术联合脾脏切除治疗胃癌的Meta分析

摘要

Objective To evaluate the effect of radical gastrectomy (RG) combined with splenectomy (SE) on long-term outcomes of patients with gastric cancer by a Meta-analysis.Methods A search of databases to identify randomized controlled trials ( RCTs) in PubMed, Cochrane, Web of knowledge, Ovid, SpringerLink, CNKI, WanFang data were per-formed.Outcome measures were survival rate, operation-related events, postoperative mortality (30 days).The Meta-a-nalysis was performed by RevMan 5.3.Results Five RCT studies met the inclusion criteria, including 588 patients in SE group and 756 patients in splean-preserving group.There was no significant difference in the 5-year overall survival rate between SE group and spleen-preserving group (OR=0.80, 95%CI:0.60~1.06, P>0.05).Sensitivity analysis indi-cated the 5-year overall survival rate in SE group was lower than that in spleen-preserving group ( OR=0.72, 95%CI:0.53~0.97, P<0.05);The complications rate in SE group was higher than that in spleen-preserving group (OR=2.51, 95%CI:1.90~3.33, P<0.05);There was no significant difference in postoperative mortality (30 days) between the two groups (OR=1.57,95%CI:0.59~4.23, P>0.05).Conclusion SE did not show a beneficial effect on survival rate compared with splenic preservation.Routinely performing SE should not be recommended.%目的：评估胃癌根治术（ radical gastrectomy， RG）联合脾脏切除术（ splenectomy， SE）治疗进展期胃癌的长期效果。方法以PubMed、Cochrane、Web of knowledge、Ovid SpringerLink、中国知网、万方、维普为数据源，检索相关文献，采用RevMan对切脾与保脾的RG随机对照试验（ RCT）进行Meta分析，结局变量为患者5年生存率、手术操作相关并发症、术后30 d死亡率。结果符合纳入标准的RCT研究共5篇，包括1344例病例，切脾组588例，保脾组756例，切脾组与保脾组5年生存率比较，差异无统计学意义（OR＝0．80，95％CI：0．60～1．06，P＞0．05），灵敏性分析切脾组患者5年生存率低于保脾组（OR＝0．72，95％CI：0．53～0．97，P＜0．05）；切脾组操作相关并发症发生率明显高于保脾组（OR＝2．51，95％CI：1．90～3．33，P＜0．05），两组术后30 d死亡率比较差异无统计学意义（ OR＝1．57，95％CI：0．59～4．23，P＞0．05）。结论 SE并不能有效改善患者预后，反而增加了术后并发症的发生，暂不推荐SE作为进展期胃癌的常规术式。