早期消化道肿瘤内镜黏膜下剥离术和外科手术治疗 的有效性和安全性Meta分析

Effectiveness and safety of endoscopic submucosal dissection and surgical treatment of gastrointestinal cancer:a meta-analysis

摘要:

目的 比较内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）和外科手术在治疗早期消化道肿瘤的有效性、安全性及医疗费用等方面的差异。 方法 检索1990年1月~2013年4月Cochrane Library、Pubmed、Embase、万方数据库、维普数据库及中国知网数据库上发表的有关ESD与外科手术治疗早期消化道肿瘤比较研究的所有中英文献，通过纳入和排除标准选定纳入文献后，采用Revman5.2软件进行Meta分析。 结果 最终纳入1篇随机对照研究和7篇回顾性队列研究，共涉及2 136个研究对象。Meta分析显示，ESD与外科手术相比，治愈性切除率（593/636，93.2% vs 270/290，93.1%，P =0.89）、术后复发率（3/304，0.98% vs 8/219，3.65%，P =0.05）、手术时间（61～131 min vs 100～265 min，P =0.23）及住院费用（16 507～22 932 RBM vs 33 902～57 994 RMB，P =0.12）方面差异无显著性，外科手术虽然整块切除率（353/353，100%）高于ESD组（299/340，87.9%，P =0.001），但并发症发生率明显增多（142/809，17.6% vs 80/1 267，6.3% P <0.001），住院时间明显延长（2.5～13.0 d vs 4.0～18.9 d，P =0.001）。 结论 早期消化道肿瘤的治疗，ESD与外科手术的疗效相当，但ESD较外科手术并发症少、住院时间短且恢复快，应作为首选方法。

Abstract:

【Objective】 To compare the safety, efficacy and clinical expense of the endoscopic submucosal dissection (ESD) with surgical operation in the treatment of early gastrointestinal cancer. 【Methods】 The Cochrane library, Pumed, Embase, Wanfang, VIP and CNKI in Chinese and English from January 1990 to April 2013 were searched to compare ESD with surgical operation for gastrointestinal cancer. The literatures were selected by the inclusion and exclusion criteria. The statistical analysis were carried out using RevMan 5.2 software. 【Results】 One randomized controlled study and seven nonrandomized retrospective cohort studies (total 2136 participants,seven full-text and one abstracts) were included . Meta-analysis showed that there was no statistically significant differences in curative resection rate (593/636, 93.2% vs 270/290, 93.1%, P =0.89), recurrence rates (3/304, 0.98% vs 8/219, 3.65%, P =0.05),operation time (61~131 min vs 100~265 min, P =0.23) and hospitalization costs (16507~22932 RMB vs 33902~57994 RMB, P =0.12) between ESD and surgery. Surgery had higher en bloc resection rate than ESD (353/353, 100% vs 299/340, 87.9%, P =0.001). However, it had significant higher complication (142/809, 17.6% vs 80/1267, 6.3%, P <0.001) and longer hospitalization time (2.5~13.0 d vs 4.0~18.9 d, P =0.001). 【Conclusion】 ESD and surgical operation have basically equivalent efficacy for the treatment of early gastrointestinal tumors. However, ESD should be the first choice because of its fewer complications, shorter hospitalization time and faster recovery period .