食管癌切除术后不同重建途径随机对照试验Meta分析

Meta-analysis of randomised controlled trials for route of reconstruction after esophagectomy for cancer

目的：评估食管癌切除术后食管胃经胸骨后或食管床2种重建途径吻合对患者术后的影响。方法：计算机检索Coeharane Library、PubMed、EMBASE、中国生物医学文献数据库、中国期刊全文数据库和中文科技期刊全文数据库，检索时间从各数据库建库至2012-12；同时辅助其他检索，纳入食管癌切除术后食管胃经胸骨后或食管床2种重建途径吻合的随机对照试验（randomized controlled trial，RCT）。由2名评价者独立评价纳入研究的质量并提取资料，用Rev—Man5．0软件进行统计分析。结果：共纳入11篇RCT，中文3篇，英文8篇，共998例患者。Meta分析结果显示，与胸骨后重建途径比较，食管床途径能明显减少食管胃吻合口瘘发生率（OR一0．52，95％CI：0．33～0．82，P=0．005）和吻合口狭窄的发生率（OR=0．40，95％CI：0．25～0．66，P〈0．001），心、肺并发症和住院死亡率差异无统计学意义，其0R值（95％CI）分别为0．50（0．24～1．04）、0．98（0．58～1．65）和0．97（0．27～3．39），P值分别为0．06、0．93和0．96。结论：食管癌切除术后食管胃经食管床途径较胸骨后途径能明显减少吻合口瘘和吻合口狭窄的发生率，使患者受益。

OBJECTIVE：To evaluate the effects of different routes of reconstruction on patient outcomes after esophagectomy for cancer. METHODS：CBM, VIP, CNKI,Coehrane Library, Pubmed and Embase etc were searched by computer since the establishment of these datebases to December 2012. We also traced related references and experts in this field and communicated with other authors to obtain certain informations that had not been found. Randomized and quasi-randomized controlled trials compared route of gastric conduit reconstruction after esophageetomy for cancer were included. The statistical software RevMan 5.0 was used. RESULTS：Totally 11 published articals were selected （998 patients） including Chinese articls and English articles. The results of Meta-analysis showed that compared with retrosternal route,posterior mediastinal route reduced the rates of anastomotic leaks and anastomotic strictures, （OR = 0. 52,95 % CI：0.33- 0.82, P = 0.005 ;OR= 0.40,95% CI： 0.25 - 0.66, P〈0.001）. There was not any difference in operative mortality, cardiac complications and pulmonary complications for the two routes of reconstruction（OR= 0.50,95 % CI ： 0.24 - 1.04, P = 0.06 ; OR = 0.98,95% CI：0.58-1.65,P=0.93;OR=0.97,95%CI：0.27-3.39,P=0.96）. CONCLUSION：compared with retrosternal route,posterior route of reconstruction reduces the rates of anastomotic leaks and anastomotic strictures.