不同食管胃吻合方式对术后并发症影响的Meta分析

Comparison of Hand-Sewn and Stapled Esophagogastric Anastomoses: A Meta-Analysis

目的探讨手工吻合与器械吻合(端侧吻合和侧侧吻合)对食管胃吻合术后吻合口并发症及死亡率的影响。方法计算机检索PubMed、Cochrane图书馆临床对照试验资料库,检索时间均从建库至2012年2月,收集比较手工吻合与器械吻合(端侧吻合和侧侧吻合)对食管胃吻合术后并发症的随机对照研究,对符合纳入标准的临床研究进行质量评价和资料提取后,采用RevMan5.0软件进行Meta分析。结果共纳入11项研究,合计1207例患者;所有的研究均是前瞻性研究,均未采用盲法,Jadad评分4分的8篇,3分的3篇。各研究间无显著异质性,采用固定效应模型分析。11个研究报道了吻合口瘘发生率,术后吻合口瘘发生率差异无统计学意义(优势比1.07,95%可信区间0.67～1.73,P=0.77)。10个研究报道了术后良性吻合口狭窄率,环形吻合器吻合组吻合口狭窄率高于手工吻合组(优势比2.20,95%可信区间1.54～3.15,P<0.01),差异有统计学意义。1个研究报道了侧侧吻合方法,吻合口瘘及狭窄发生率均显著低于环形吻合器吻合及手工吻合。7个研究报道了术后住院死亡率(优势比1.29,95%可信区间0.59～2.85,P=0.527),不同吻合方式间术后住院死亡率差异无统计学意义。所有研究无明显发表偏倚。结论不同吻合方式(手工吻合、器械端侧吻合和器械侧侧吻合)对食管胃吻合术后吻合口瘘发生率、死亡率无显著影响,但环形吻合器行食管胃端侧吻合较手工吻合术后良性吻合口狭窄率显著增高。

Objective To investigate the impact of hand-sewn and stapled esophagogastric anastomoses on postoperative mortality, anastomostic leak and fibrosis stricture. Methods Such databases as PubMed and Central Register of Controlled Trials （from the date of their establishments to February 2012） were searched. Eligible studies accessed the postoperative complications after hand-sewn and stapled esophagogastric anastomoses of which randomized control trials were collected. Quality assessment and data extraction were performed in those clinical trials. RevMan 5.0 software was applied to carry out the meta-analysis. Results Eleven relevant studies with 1 207 patients were included. All the studies were prospective but unblinded because of performing surgery. There were 8 studies with Jadad score 4, and 3 studies with Jadad score 3. Eleven studies reported the incidence of anastomostic leak, no significant heterogeneity between the 11 trials and fixed model was used to analysis. The combined OR=l.07, 95%CI 0.67-1.73, P=0.77. There was no statistically difference between the incidences of postoperative anasotmostic leaks. Ten studies reported the incidence of anastomostic stricture, the combined OR=2.20,95%CI 1.54-3.15, P〈O.01. The incidence of postoperative anasotmostic stricture in circular stapled anastomoses patients was statistically higher than that in hand-sewn anastomosed patients. Seven studies reported the postoperative mortality. The combined OR=1.29, 95%CI 0.59~2.85, P=0.52. There was no statistically difference between the mortality. Only one study compared side- side anastomosis and reported a lower incidence of postoperative anastomostic leak and stricture. No obvious publication bias existed. Conclusion Circular stapled esophagogastric anastomoses increased the incidence of postoperative anastomostic stricture comparing with the hand-sewn anastomosed.