半机械吻合与手工吻合对食管癌切除食管胃吻合口并发症发生率影响的系统评价与Meta分析

Comparison of Influence of Semi-mechanical and Hand-sewn Esophagogastric Anastomoses on Postoperative Anastomotic Complications:A Systematic Review and Meta-analysis

目的分析食管癌切除术后患者行食管胃半机械吻合与手工吻合对患者术后吻合口并发症发生率影响的差异。方法计算机检索PubMed、OVID数据库、中国期刊全文数据库(CNKI)、中国生物医学文献数据(CBM),检索时间均从建库至2013年12月,并手工检索相关杂志,纳入比较半机械吻合与手工吻合对食管癌术后患者吻合口并发症发生率影响的随机对照研究或观察性研究。评价纳入文献质量、提取数据,采用RevMan 5.2软件进行Meta分析。结果共纳入12篇文献,包括随机对照试验3篇,观察性研究9篇,共1 271例患者。各研究间无统计学异质性,故采用固定效应模型进行Meta分析。结果显示两组患者术后吻合口瘘发生率差异有统计学意义[随机对照研究RR=0.34,95%CI(0.12,0.97),P<0.05;观察性研究OR=0.40,95%CI(0.26,0.62),P<0.05]。12篇文献均报道了患者术后吻合口狭窄发生率,Meta分析结果显示两组患者术后吻合口狭窄发生率差异有统计学意义[随机对照研究RR=0.14,95%CI(0.04,0.47),P<0.05;观察性研究OR=0.22,95%CI(0.15,0.34),P<0.000 1]。结论与手工吻合比较,食管癌切除术后患者食管胃半机械吻合能降低吻合口瘘和吻合口狭窄的发生率。由于纳入研究数量偏小,质量不高,上述结论仍需大样本、高质量的随机或非随机对照试验进一步验证。

Objective To investigate the influence of semi-mechanical and hand-sewn esophagogastfic anastomoses on postoperative anastomostic complications in patients undergoing esophagectomy. Methods A systematic, computer- aided literature search was performed in PubMed, OVID, CNKI and BioMed databases for studies which were published from database establishment to December 2013. A manual literature search was also performed. We included randomized controlled trials （RCT） and observational studies which investigated the influence of semi-mechanical and conventional hand-sewn esophagogastric anastomoses on postoperative anastomostic complications. Quality assessment and data extraction were performed, and RevMan 5.2 was used for meta-analysis. Results Twelve relevant studies with 1 271 patients were included （3 RCTs and 9 observational studies）. No significant heterogeneity among the 12 trials was found, so fixed effects model was used for meta-analysis. There was statistical difference in the incidence of postoperative anastomotic leak between hand-sewn and semi-mechanical esophagogastric anastomoses I RCT RR=0.34,95%CI（0.12,0.97）, P 〈 0.05 ; observational studies OR=0.40, 95%CI （0.26, 0.62）, P 〈 0.05 1. Postoperative incidence of anastomostic stricture was reported in all 12 studies. There was statistical difference in the incidence of postoperative anastomotic stricture between hand-sewn and semi-mechanical esophagogastric anastomoses I RCT RR=0.14, 95%CI （0.04, 0.47）, P 〈 0.05; observational studies OR=0.22, 95%CI （0.15, 0.34）, P 〈 0.000 11. Conclusions Compared with conventional hand-sewn anastomosis, semi-mechanical esophagogastric anastomosis can significantly reduce the incidence of postoperative anas- tomostic leak and stricture. Due to limited quantity and quality of included studies, more high-quality studies with larger sample size including RCT and non-randomized studies are needed to confirm these findings.