胃癌术后胆石症发病相关因素的Meta分析

Related factors of gallstone occurrence after gastrectomy for gastric cancer： a Meta-analysis

目的 评估胃癌术后胆石症发生的危险因素.方法 以Embase、Pubmed、the Cochrane Library、Web of Science数据库作为国外文献的主要来源,以万方数据知识服务平台、中国知网数据出版平台、维普期刊资源整合服务平台作为国内文献的主要来源.收集1990-2014年公开发表的有关胃癌术后胆石症发病因素的中文和英文文献,应用Revman 5.3进行Meta分析.结果共纳入24篇文献,其中3篇随机对照研究（RCT）,13篇队列研究和8篇病例对照研究.24篇文章病例数32～893例不等.Meta分析结果显示：消化道生理性重建术后比消化道非生理性重建后胆石症发生率低[OR：0.53; 95％ CI（0.44 ～0.65）;P＜0.05];全胃切除术后比远端胃切除术后胆石症发病率高[OR：1.98;95％ CI（1.29 ～3.04）;P＜0.05];淋巴结D1清除比淋巴结D2清除胆石症发病率低[OR：0.38;95％CI（0.21 ～0.72）;P ＜0.05];保留迷走神经组比不保留迷走神经组术后胆石症发病率低[OR：0.24;95％ CI（0.13 ～0.45）;P＜0.05];保留幽门胃切除术组与不保留幽门胃切除术组术后胆石症发病率无明显差异[OR：0.70;95％ CI（0.48～ 1.02）;P＞0.05].结论 生理性消化道重建与保留迷走神经胃切除能够降低术后胆石症的发生率,全胃切除增加术后胆石症发病率,淋巴结清扫程度越高,术后胆石症发生的风险越大.保留幽门及不保留幽门胃切除术后胆结石发病率无明显区别.

Objective To evaluate the risk factors of gallstone occurrence after gastrectomy for gastric cancer.Methods Relevant documents published from 1990 to 2014 were retrieved through Pubmed,Cochrane Library,Embase,Web of Science CNKI,Wan Fang and VIP databases search.The Meta-analysis was applied with RevMan 5.3 software for Odds ratio and 95% CI.Results 24 studies were selected for this Meta-analysis which included 3 randomized controlled trials,13 cohort studies and 8 case-controlled studies.These 24 studies included patient number which ranged from 32 to 893.The pooled OR （95% CI） and P values of OR （95 % CI） for physiologic digestive tract reconstruction were 0.53 （0.44 ～ 0.65,P 〈 0.05） ;amount of resection of stomach,1.98 （1.29 ～ 3.04,P 〈 0.05） ; lymphadenectomy,0.38 （0.21 ～ 0.72,P 〈 0.05） ; vagotomy,0.24 （0.13 ～ 0.45,P 〈 0.05） ; and pylorus preservation,0.70 （0.48 ～ 1.02,P 〉 0.05）.Conclusions Physiologic digestive tract reconstruction and vagus nerve preservation reduced occurrence of gallstones after gastrectomy.On the other hand,total gastrectomy and extensive lymph node dissection increased the occurrence.There was no significant difference in the occurrence of gallstones whether there was pylorus preservation or not.