机械与手工食管胃吻合术后吻合口瘘发生率比较的系统评价

Hand-Suture versus Stapling Anastomosis in the Incidence of Anastomotic Leakage Following Esophagogastrostomy:A Systematic Review

目的系统评价机械与手工食管胃吻合术后吻合口瘘发生率。方法计算机检索CBM(1978～2012.2)、VIP(1989～2012.2)、CNKI(1994～2012.2)、WanFang Data(1980～2012.2)、The Cochrane Library、PubMed(1966～2012.2)、EMbase(1974～2012.2)以及相关临床试验网站,查找比较机械与手工食管胃吻合术后患者吻合口瘘发生率的随机和半随机对照试验,并运用Google Scholar、Medical Martix等搜索引擎,查找相关参考文献及灰色文献,手工检索《中华肿瘤学》等相关中文期刊。按照纳入和排除标准筛选文献、提取资料并评价纳入研究的方法学质量后,采用RevMan 5.0软件进行Meta分析。结果最终纳入9个RCT,2 202例患者。Meta分析结果显示:机械吻合术后患者吻合口瘘发生率低于手工吻合[OR=0.43,95%CI(0.26,0.71),P<0.01]。结论机械吻合在降低食管胃吻合术后患者吻合口瘘发生率方面优于手工吻合。受纳入研究质量和数量限制,上述结论尚需开展更多高质量研究加以验证。

Objective To assess the effectiveness and safety of hand-suture vs. stapling anastomosis in esophagogas- trostomy. Methods The following databases such as CBM （1978 to February 2012）, VIP （1989 to February 2012）, CNKI （1994 to February 2012）, WanFang Data （1980 to February 2012）, The Cochrane Library, PubMed （1966 to February 2012）, EMbase （1974 to February 2012）, and relevant webs of clinical trials were searched to collect the randomized con- trolled trials （RCTs） and quasi-RCTs about hand-suture vs. stapling anastomosis in the incidence of anastomotic leakage following esophagogastrostomy. Moreover, relevant references and grey literature were retrieved on web engines includ- ing Google Scholar and Medical Martix, and the Chinese periodicals e.g. Chinese ]ournal of Oncology were also hand- searched. According to the inclusion and exclusion criteria, the literature, was screened, the data were extracted, and the quality of the included studies was assessed. Then meta-analysis was conducted using R.＇vMan 5.0 software. Results A total of 9 RCTs involving 2 202 patients were included. The result of meta-analysis was as follows： the incidence of anas- tomotic leakage in the stapling anastomosis group was lower than that in the hand-suture anastomosis group （OR=0.43, 95%CI 0.26 to 0.71, P〈0.01）. Conclusion Stapling anastomosis is superior to hand-suture anastomosis in reducing the incidence of anastomotic leakage following esophagogastrostomy. For the limited quality and quantity of the included studies, this conclusion has to be further proved by more high-quality studies.