目的：探讨完全腹腔镜远端胃癌根治术（TLDG）与腹腔镜辅助远端胃癌根治术（LADG）的安全性和有效性。方法：计算机检索 PubMed、Cochrane Library、中国期刊全文数据库（CNKI）和数字化期刊全文数据库（万方数据库），收集2004—2014年间发表的 TLDG 与 LADG 对比的文献，利用 RevMan 5.3软件进行Meta 分析。结果：共10篇文献被纳入本次 Meta 分析，共计2212例胃癌患者，其中 TLDG 组930例，LADG组1282例。本次 Meta 分析结果显示，与 LADG 组比较，TLDG 组术中出血少[均数差（WMD）＝－20.70，95％CI：－30.81～－10.59，P ＜0.01]、术后止痛剂使用次数少（WMD＝－0.38，95％CI：－0.74～－0.02， P ＝0.04）和淋巴结清扫数目多（WMD＝2.98，95％CI：0.71～5.26，P ＝0.01），而手术时间、术后首次排气时间、首次进流食时间、术后住院时间、近端切缘距离、术后第1天 C 反应蛋白水平、术后总体并发症及吻合口并发症发生率比较差异均无统计学意义（均 P ＞0.05）。结论：TLDG 治疗远端胃癌安全可行，可取得与传统LADG 相当的手术疗效，不增加术后并发症，且具有术中出血少和术后疼痛轻等优点。%Objective To explore the effectiveness and safety of totally laparoscopic distal gastrectomy (TLDG)and laparoscopically assisted distal gastrectomy (LADG)for gastric cancer.Methods The comparative studies of TLDG and LADG published between 2008 and 2014 were searched from PubMed,EMBASE,Chinese Biomedical Literature Database (CBM),China National Knowledge Infrastructure (CNKI). After screening for inclusion, data extraction,and quality assessment,RevMan 5.3 software was used for Meta-analysis.Results Ten studies of 2 212 patients were included in the Meta-analysis,among whom 930 cases underwent TLDG and 1 282 cases underwent LADG.The results of Meta-analysis indicated that compared with LADG,TLDG had the advantages of less blood loss (WMD= - 20.70,95%CI:- 30.81 - - 10.59,P <0.01),less usage of analgesic (WMD=-0.38,95%CI:-0.74 - -0.02,P =0.04),more retrieved lymph nodes (WMD= 2.98,95%CI:0.71 -5.26,P =0.01).However,the Meta-analysis showed no statistically significant differences in the operation time, postoperative time-to-first flatus and oral intake,postoperative hospital stay,length of proximal resection margin, C reaction protein (CRP)level at postoperative day 1,incidence of overall complications and anastomosis-related complications.Conclusion TLDG is safe and effective with less blood loss, less pain than those of LADG. Moreover,it has comparable results to conventional LADG,with no increase of postoperative complications.
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