全胃切除Roux-en-Y加空肠储袋吻合术疗效系统评价

Effect of Roux-en-Y reconstruction with jejunal pouch after total gastrectomy:a systematic review

目的 评价全胃切除Roux-en-Y加空肠储袋吻合术的有效性及安全性，为进一步临床研究与循证临床实践提供参考依据。方法 计算机检索有关Roux-en-Y加空肠储袋对比单纯Roux-en-Y的随机对照试验（RCT）资料，检索时间截至2010年10月。由2位研究者逐篇评价纳入研究的质量、交叉核对提取数据，并采用RevMan 5.0软件进行数据处理。结果 共纳入12篇RCT，共577例病人。Meta分析显示：与单纯Roux-en-Y相比，Roux-en-Y加空肠储袋有助于改善术后3个月和6个月的体重，提高术后1和2年的生活质量，降低术后3、6和12~15个月倾倒综合征发生率。另外，两者的手术死亡率、手术并发症发生率及手术时间的差异无统计学意义。结论 Roux-en-Y加空肠储袋与单纯Roux-en-Y吻合术相比在术后近期内存在优势，而远期疗效仍须进一步研究证实。

Objective To evaluate the curative effectiveness and safety of Roux-en-Y reconstruction with jejunal pouch after total gastrectomy to provide reference for the further clinical study and evidence based clinical practice. Methods Systematic literature retrieval was carried out to obtain studies of randomized controlled trials comparing Roux-en-Y reconstruction with jejunal pouch and simple Roux-en-Y after total gastrectomy before October 2010. Study selection, data collection and methodological quality assessment of studies were performed by two individual reviewers. A meta-analysis was performed by RevMan 5.0 software. Results Twelve RCTs involving 577 patients met the selection criteria. Meta-analyses showed that Roux-en-Y reconstruction with jejunal pouch was better than simple Roux-en-Y in terms of 3- and 6-month body weight, 1- and 2- year quality of life and reducing the incidence of dumping at 3, 6 and 12~15 months after surgery. The postoperative complication incidence, postoperative morbidity and operation time were similar between the two groups. Conclusion The efficacy of Roux-en-Y reconstruction with jejunal pouch on the digestive tract reconstruction is better than that of Roux-en-Y alone in the early time. However, further studies are needed to confine the long-term effect of the former.