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目的:评价胃癌根治术中行完整网膜囊切除的效果。方法:检索2014年10月以前公开发表的比较行完整与不完整网膜囊切除在胃癌根治术中应用情况的文献。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 Man 5.0软件对所纳入的数据进行Meta分析。结果:最终纳入7项研究,共1 224例患者,其中完整网膜囊切除组486例,非完整网膜囊切除组738例。Meta分析结果显示,与非完全网膜囊切除组比较,完整网膜囊创伤相关并发症发生率较高(OR=2.1,95%CI=1.05~4.21,P=0.04);术后总并发症情况、肠梗阻、吻合口相关并发症、肺部感染等并发症情况差异无统计学意义(均P>0.05);两组术后3、5年总生存率(OR=1.35,95%CI=0.82~2.21;OR=1.03,95%CI=0.82~1.63)及术后复发率(OR=0.90,95%CI=0.66~1.22)均无统计学差异(均P>0.05)。结论:D1、D2胃癌根治术中进行完整网膜囊切除可能增加创伤相关并发症的风险,在提高患者生存率和降低肿瘤复发率方面无明显优势。
Objective: To evaluate the effect of complete omentum resection in radical operation of gastric cancer. METHODS: We searched the literature published before October 2014 on the comparison of complete and incomplete omentum excision in radical resection of gastric cancer. 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 Rev Man 5.0 software. RESULTS: Seven studies were enrolled in a total of 1224 patients, of which 486 were intact omentum and 738 were non-intact omentum. Meta-analysis showed that the incidence of complications related to intact omentum sac was higher than that of non-complete omentum resection group (OR = 2.1,95% CI = 1.05-4.21, P = 0.04); postoperative complications (OR = 1.35, 95% CI = 1.35, P <0.05). There was no significant difference in complications, intestinal obstruction, anastomotic complications and pulmonary infection among the two groups (all P> 0.05) 0.82 ~ 2.21; OR = 1.03, 95% CI = 0.82 ~ 1.63) and postoperative recurrence rate (OR = 0.90,95% CI = 0.66 ~ 1.22). Conclusion: The complete omentum resection of radical resection of D2 and D2 gastric cancer may increase the risk of trauma-related complications, and there is no obvious advantage in improving the survival rate and reducing the recurrence rate.