腹腔鏡切除術治療胃間質瘤療效與安全性的系統評價_《中國循證醫學雜志》

作者：

 梁冀望 ¹ , 鄭志超 ¹ , 張濤 ¹ , 趙巖 ¹ , 王怡 ² , 劉勇 ¹

1. 遼寧省腫瘤醫院胃外科（沈陽?110042）；2. 遼寧省腫瘤醫院麻醉科（沈陽?110042）;

關鍵詞：

胃間質瘤腹腔鏡切除開腹切除 Meta 分析系統評價

DOI：

10.7507/1672-2531.20110140

視頻：

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目的　系統評價腹腔鏡切除術治療胃間質瘤的療效和安全性。
方法　按Cochrane系統評價方法，計算機檢索PubMed、EMbase、Wiley Online Library、MEDLINE、CNKI、VIP、CBM數據庫，檢索時間從建庫截止2010年12月，并手工檢索相關文獻，查找腹腔鏡與開腹術比較治療胃間質瘤的隨機和非隨機對照試驗。由2位研究者按照納入排除標準篩選文獻、評價質量并提取資料后，采用RevMan 5.0軟件進行Meta分析。
結果　納入4個半隨機對照試驗和8個同期的臨床對照試驗，共496例患者。Meta分析結果顯示：與開腹術相比，腹腔鏡手術住院時間短［MD= –2.81，95%CI（–4.51，–1.11）］，術后復發及轉移發生率低［OR= 0.36，95%CI（0.13，1.01）］。但兩組在手術時間、出血量、首次排氣和進食時間、并發癥方面，其差異均無統計學意義（P gt;0.05）。
結論　現有研究顯示，腹腔鏡手術治療胃間質瘤在減少住院時間、降低復發和轉移發生率方面優于傳統開腹手術。由于納入研究方法學質量較低且數量少，期待更多高質量的隨機對照試驗以提供更高質量的證據。

引用本文： 梁冀望,鄭志超,張濤,趙巖,王怡,劉勇. 腹腔鏡切除術治療胃間質瘤療效與安全性的系統評價. 中國循證醫學雜志, 2011, 11(7): 819-825. doi: 10.7507/1672-2531.20110140 復制

1.	1 Miettinen M, Lasota J. Gastrointestinal stromal tumors--definition, clinical, histological, immunohistochemical,and molecular genetic features and differential diagnosis. Virchows Arch , 2001, 438(1): 1-12.
2.	2 Gelen T, Elpek GO, Aksoy NH, et al . p27 labeling index and proliferation in gastrointestinal stromal tumors:correlations with clinicopathologic factors and recurrence. Jpn J Clin Oncol , 2003, 33(7): 346-352.
3.	3 D'amato G, Steinert DM, Mcauliffe JC, et al . Update on the biology and therapy of gastrointestinal stromal tumors. Cancer Control , 2005, 12(1): 44-56.
4.	4 Rossi CR, Mocellin S, Mencarelli R, et al . Gastrointestinal stromal tumors:from a surgical to a molecular approach. Int J Cancer , 2003, 107(2): 171-176.
5.	5 Joensuu H, Fletcher C, Dimitrijevic S, et al . Management of malignant gastrointestinal stromal tumours. Lancet Oncol , 2002, 3(11): 655-664.
6.	6 Matthews BD, Walsh RM, Kercher KW, et al . Laparoscopic vs open resection of gastric stromal tumors. Surg Endosc , 2002, 16(5): 803-807.
7.	7 Catena F, Di BM, Fusaroli P, et al . Laparoscopic treatment of gastric gist:report of 21 cases and literature's review. J Gastrointest Surg , 2008, 12(3): 561-568.
8.	8 Wu JM, Yang CY, Wang MY, et al . Gasless laparoscopy-assisted versus open resection for gastrointestinal stromal tumors of the upper stomach:preliminary results. J Laparoendosc Adv Surg Tech , 2010, 20(9): 725-729.
9.	9 Nishimura J, Nakajima K, Omori T, et al . Surgical strategy for gastric gastrointestinal stromal tumors: laparoscopic vs . open resection. Surg Endosc , 2007, 21(6): 875-878.
10.	10 Sarela AI. Entirely laparoscopic radical gastrectomy for adenocarcinoma: lymph node yield and resection margins. Surg Endosc , 2009, 23(1): 153-160.
11.	11 Goh BK, Chow PK, Chok AY, et al . Impact of the introduction of laparoscopic wedge resection as a surgical option for suspected small/medium-sized gastrointestinal stromal tumors of the stomach on perioperative and oncologic outcomes. World J Surg , 2010, 34(8): 1847-1852.
12.	12 Silberhumer GR, Hufschmid M, Wrba F, et al . Surgery for gastrointestinal stromal tumors of the stomach. J Gastrointest Surg , 2009, 13(7): 1213-1219.
13.	13 Ishikawa K, Inomata M, Etoh T, et al . Long-term outcome of laparoscopic wedge resection for gastric submucosal tumor compared with open wedge resection. Surg Laparosc Endosc Percutan Tech , 2006, 16(2): 82-85.
14.	14 Pitsinis V, Khan AZ, Cranshaw I, et al . Single center experience of laparoscopic vs . Open Resection for Gastrointestinal Stromal Tumors of the Stomach. Hepatogastroenterology , 2007, 54(74): 606-608.
15.	20 Schulz KF, Chalmers I, Hayes RJ, et al . Empirical evidence of bias. dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA , 1995, 273(5): 408-412.
16.	21 Casali PG, Jost L, Reichardt P, et al . Gastrointestinal stromal tumours: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol , 2009, 20(Suppl 4): 64-67.
17.	22 Tryggvason G, Gislason HG, Magnusson MK, et al . Gastrointestinal stromal tumors in iceland. The Icelandic Gist Study, a Population-Based Incidence and Pathologic Risk Stratification Study. Int J Cancer , 2005, 117(2): 289-293.
18.	23 Lukaszczyk JJ, Preletz RJ. Laparoscopic resection of benign stromal tumor of the stomach. J Laparoendosc Surg , 1992, 2(6): 331-334.
19.	24 Nguyen SQ, Divino CM, Wang JL, et al . Laparoscopic management of gastrointestinal stromal tumors. Surg Endosc , 2006, 20(5): 713-716.
20.	25 Mochizuki Y, Kodera Y, Fujiwara M, et al . Laparoscopic wedge resection for gastrointestinal stromal tumors of the stomach: initial experience. Surg Today , 2006, 36(4): 341-347.
21.	26 Cheng HL, Lee WJ, Lai IR, et al . Laparoscopic wedge resection of benign gastric tumor. Hepatogastroenterology , 1999, 46(27): 2100-2104.
22.	27 Hindmarsh A, Koo B, Lewis MP, et al . Laparoscopic resection of gastric gastrointestinal stromal tumors. Surg Endosc , 2005, 19(8): 1109-1112.
23.	28 Novitsky YW, Kercher KW, Sing RF, et al . Long-term outcomes of laparoscopic resection of gastric gastrointestinal stromal tumors. Ann Surg , 2006, 243(6): 738-745.
24.	王港, 付衛, 王德臣, 等. 腹腔鏡與開腹胃間質瘤契形切除的臨床對比研究. 中國微創外科雜志, 2010, 10(2): 126-129.
25.	許東, 吳碩東, 于宏. 胃間質瘤的腹腔鏡手術與開腹手術的臨床對比研究. 生物醫學工程與臨床, 2009, 13(2): 123-125.
26.	周迪, 張勇, 龔偉, 等. 腹腔鏡聯合胃鏡行胃間質瘤切除術的臨床分析. 腹腔鏡外科雜志, 2009, 14(7): 526-529.
27.	李河, 麥勁壯, 方積乾, 等. Meta分析中漏斗圖的繪制. 循證醫學, 2007, 7(2): 101-104, 106.
28.	康德英, 洪旗, 劉關鍵, 等. Meta分析中發表性偏倚的識別與處理. 中國循證醫學雜志, 2003, 3(1): 45-49.
29.	錢鋒, 余佩武, 王自強, 等. 腹腔鏡胃間質瘤切除術30例. 中華胃腸外科雜志, 2007, 10(1): 33-34.

1. 1 Miettinen M, Lasota J. Gastrointestinal stromal tumors--definition, clinical, histological, immunohistochemical,and molecular genetic features and differential diagnosis. Virchows Arch , 2001, 438(1): 1-12.
2. 2 Gelen T, Elpek GO, Aksoy NH, et al . p27 labeling index and proliferation in gastrointestinal stromal tumors:correlations with clinicopathologic factors and recurrence. Jpn J Clin Oncol , 2003, 33(7): 346-352.
3. 3 D'amato G, Steinert DM, Mcauliffe JC, et al . Update on the biology and therapy of gastrointestinal stromal tumors. Cancer Control , 2005, 12(1): 44-56.
4. 4 Rossi CR, Mocellin S, Mencarelli R, et al . Gastrointestinal stromal tumors:from a surgical to a molecular approach. Int J Cancer , 2003, 107(2): 171-176.
5. 5 Joensuu H, Fletcher C, Dimitrijevic S, et al . Management of malignant gastrointestinal stromal tumours. Lancet Oncol , 2002, 3(11): 655-664.
6. 6 Matthews BD, Walsh RM, Kercher KW, et al . Laparoscopic vs open resection of gastric stromal tumors. Surg Endosc , 2002, 16(5): 803-807.
7. 7 Catena F, Di BM, Fusaroli P, et al . Laparoscopic treatment of gastric gist:report of 21 cases and literature's review. J Gastrointest Surg , 2008, 12(3): 561-568.
8. 8 Wu JM, Yang CY, Wang MY, et al . Gasless laparoscopy-assisted versus open resection for gastrointestinal stromal tumors of the upper stomach:preliminary results. J Laparoendosc Adv Surg Tech , 2010, 20(9): 725-729.
9. 9 Nishimura J, Nakajima K, Omori T, et al . Surgical strategy for gastric gastrointestinal stromal tumors: laparoscopic vs . open resection. Surg Endosc , 2007, 21(6): 875-878.
10. 10 Sarela AI. Entirely laparoscopic radical gastrectomy for adenocarcinoma: lymph node yield and resection margins. Surg Endosc , 2009, 23(1): 153-160.
11. 11 Goh BK, Chow PK, Chok AY, et al . Impact of the introduction of laparoscopic wedge resection as a surgical option for suspected small/medium-sized gastrointestinal stromal tumors of the stomach on perioperative and oncologic outcomes. World J Surg , 2010, 34(8): 1847-1852.
12. 12 Silberhumer GR, Hufschmid M, Wrba F, et al . Surgery for gastrointestinal stromal tumors of the stomach. J Gastrointest Surg , 2009, 13(7): 1213-1219.
13. 13 Ishikawa K, Inomata M, Etoh T, et al . Long-term outcome of laparoscopic wedge resection for gastric submucosal tumor compared with open wedge resection. Surg Laparosc Endosc Percutan Tech , 2006, 16(2): 82-85.
14. 14 Pitsinis V, Khan AZ, Cranshaw I, et al . Single center experience of laparoscopic vs . Open Resection for Gastrointestinal Stromal Tumors of the Stomach. Hepatogastroenterology , 2007, 54(74): 606-608.
15. 20 Schulz KF, Chalmers I, Hayes RJ, et al . Empirical evidence of bias. dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA , 1995, 273(5): 408-412.
16. 21 Casali PG, Jost L, Reichardt P, et al . Gastrointestinal stromal tumours: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol , 2009, 20(Suppl 4): 64-67.
17. 22 Tryggvason G, Gislason HG, Magnusson MK, et al . Gastrointestinal stromal tumors in iceland. The Icelandic Gist Study, a Population-Based Incidence and Pathologic Risk Stratification Study. Int J Cancer , 2005, 117(2): 289-293.
18. 23 Lukaszczyk JJ, Preletz RJ. Laparoscopic resection of benign stromal tumor of the stomach. J Laparoendosc Surg , 1992, 2(6): 331-334.
19. 24 Nguyen SQ, Divino CM, Wang JL, et al . Laparoscopic management of gastrointestinal stromal tumors. Surg Endosc , 2006, 20(5): 713-716.
20. 25 Mochizuki Y, Kodera Y, Fujiwara M, et al . Laparoscopic wedge resection for gastrointestinal stromal tumors of the stomach: initial experience. Surg Today , 2006, 36(4): 341-347.
21. 26 Cheng HL, Lee WJ, Lai IR, et al . Laparoscopic wedge resection of benign gastric tumor. Hepatogastroenterology , 1999, 46(27): 2100-2104.
22. 27 Hindmarsh A, Koo B, Lewis MP, et al . Laparoscopic resection of gastric gastrointestinal stromal tumors. Surg Endosc , 2005, 19(8): 1109-1112.
23. 28 Novitsky YW, Kercher KW, Sing RF, et al . Long-term outcomes of laparoscopic resection of gastric gastrointestinal stromal tumors. Ann Surg , 2006, 243(6): 738-745.
24. 王港, 付衛, 王德臣, 等. 腹腔鏡與開腹胃間質瘤契形切除的臨床對比研究. 中國微創外科雜志, 2010, 10(2): 126-129.
25. 許東, 吳碩東, 于宏. 胃間質瘤的腹腔鏡手術與開腹手術的臨床對比研究. 生物醫學工程與臨床, 2009, 13(2): 123-125.
26. 周迪, 張勇, 龔偉, 等. 腹腔鏡聯合胃鏡行胃間質瘤切除術的臨床分析. 腹腔鏡外科雜志, 2009, 14(7): 526-529.
27. 李河, 麥勁壯, 方積乾, 等. Meta分析中漏斗圖的繪制. 循證醫學, 2007, 7(2): 101-104, 106.
28. 康德英, 洪旗, 劉關鍵, 等. Meta分析中發表性偏倚的識別與處理. 中國循證醫學雜志, 2003, 3(1): 45-49.
29. 錢鋒, 余佩武, 王自強, 等. 腹腔鏡胃間質瘤切除術30例. 中華胃腸外科雜志, 2007, 10(1): 33-34.

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《中國循證醫學雜志》

腹腔鏡切除術治療胃間質瘤療效與安全性的系統評價

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