管状胃对食管癌患者术后并发症和生活质量影响的Meta分析

Postoperative Complications and Quality of Life in Patients with Esophageal Cancer after Esophagectomy using Gastric Tube: A Meta-Analysis

目的系统评价管状胃代食管对食管癌患者术后并发症和生活质量的影响。方法计算机检索PubMed、EMbase、The Cochrane Library、Web of Knowledge、CBM、CNKI、VIP和WanFang Data,查找管状胃与全胃代食管比较对食管癌患者术后并发症和生活质量影响的相关随机对照试验(RCT),检索时限均为从建库至2013年9月30日。由2位研究者按纳入与排除标准独立筛选文献、提取资料和评价质量后,采用RevMan 5.2软件进行Meta分析。结果共纳入10个RCT,1 085例患者。Meta分析结果显示:1在术后并发症方面,管状胃代食管术后反流性食管炎[OR=0.19,95%CI(0.12,0.32),P<0.000 01]和胸胃综合征[OR=0.11,95%CI(0.04,0.32),P<0.000 1]的发生率均显著低于全胃代食管,其差异均具有统计学意义。2在生活质量方面,除术后3个月外,管状胃代食管术后6个月[MD=18.71,95%CI(7.72,29.71),P=0.000 9]和12个月[MD=22.95,95%CI(8.21,37.69),P=0.002]的生活质量评分均高于全胃代食管,差异均具有统计学意义;管状胃代食管术后6个月[OR=1.78,95%CI(1.10,2.88),P=0.02]、12个月[OR=2.73,95%CI(1.67,4.47),P<0.000 1]的生活质量满意度均高于全胃代食管,且差异均具有统计学意义。结论与全胃代食管相比较,管状胃代食管可以降低食管癌患者术后反流性食管炎和胸胃综合征的发生率,并提高患者的生活质量。但对术后吻合口并发症和更长期生活质量的影响仍存在不确定因素,有待进一步研究。

Objective To systematically review the complications and quality of life （QoL） in patients with esophageal cancer after esophagectomy using gastric tube. Methods Randomized controlled trials （RCTs） about the postoperative complications and QoL of patients using gastric tube and the whole stomach reconstruction were electronically searched in PubMed, EMbase, The Cochrane Library, Web of Knowledge, CBM, CNKI, VIP and WanFang Data from inception to September 30% 2013, Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality. Then meta-analysis was performed using RevMan 5.2 software. Results A total of 10 RCTs involving i 085 patients were included. The results of meta-anatysis showed that, in terms of postoperative complications, the incidences of reflux esophagitis （OR=0.19, 95%CI 0.12 to 0.32, P〈0.000 01） and intrathoracic stomach syndrome （OR=0.11, 95%CI 0.04 to 0 than those of the whole stomach; in terms of QoL, the scores of 32, P（0.000 1） with gastric tube were significantly lower QoL in the 6th month （MD=18.71, 95%CI 7.72 to 29.71, P=0.000 9） and in the 12th month （MD=22.95, 95%CI 8.21 to 37.69, P=0.002） with gastric tube were significantly higher than those of the whole stomach. In terms of satisfaction degree of QoL, the satisfaction degree of QoL in the 6th month （OR=1.78, 95%CI 1.10 to 2.88, P=0.02） and the 12th month （OR=2.73, 95%C1 1.67 to 4.47, P〈0.000 1） with gastric tube were both significantly higher than those of the whole stomach. Conclusion Compared with the whole stomach reconstruction, the method of gastric tube reconstruction has beneficial effects in reducing the incidences of postoperative complications （such as reflux esophagitis, intrathoracic stomach syndrome） and improves patients＇ QoL. But there are many uncertain factors about postoperative anastomotic complication and its influence on patients＇ long-term QoL remains uncertain. Thus, further studies should be conducted.