两种食管上提径路对食管癌患者术后并发症影响的系统评价和Meta分析

Influence of Two Different Reconstruction Routes on Surgical Outcomes of Patients after Esophagectomy for Esophageal Carcinoma: A Systematic Review and Metaanalysis

目的系统评价食管上提径路为后纵隔径路与胸骨后径路对食管癌患者术后并发症的影响。方法计算机检索Pub Med、EMbase、CBM、VIP等数据库,检索时间从每个数据库创建至2014年4月,纳入后纵隔径路与胸骨后径路对食管癌患者术后并发症影响的随机对照试验和病例对照研究。评价纳入研究质量,提取数据,采用Rev Man 5.2软件进行Meta分析。结果共纳入23个研究,其中随机对照试验7个,病例对照研究16个。病例对照研究的Meta分析结果显示,两组术后吻合口瘘的发生率差异有统计学意义[OR=0.39,95%CI(0.30,0.50),P<0.01]。两组术后吻合口狭窄发生率差异无统计学意义[随机对照试验RR=0.80,95%CI(0.49,1.30),P=0.36;病例对照研究OR=0.64,95%CI(0.40,1.03),P=0.07]。两组术后心脏并发症发生率差异无统计学意义[随机对照试验RR=0.70,95%CI(0.46,1.06),P=0.09;病例对照研究OR=1.13,95%CI(0.70,1.81),P=0.62]。两组术后肺部并发症发生率差异无统计学意义[随机对照试验RR=1.27,95%CI(0.92,1.75),P=0.14;病例对照研究OR=0.91,95%CI0.66,1.27),P=0.59]。两组术后死亡率差异无统计学意义[随机对照试验RR=0.47,95%CI(0.19,1.16),P=0.10;病例对照研究OR=0.18,95%CI(0.03,1.01),P=0.05]。结论以食管上提径路为后纵隔径路比胸骨后径路术后吻合口瘘发生率较低。

Objective To systematically evaluate the influence of posterior mediastinal and retrosternal route on the incidence of complications in patients with esophageal carcinoma after esophagectomy. Methods A systematic literature search for studies which were published on Pub Med, EMbase, CBM, VIP was performed from database establishment to April 2014. We included randomized controlled trials and case control studies related to the influence of two routes on the incidence of complications of patients with esophagectomy. We assessed the methodology quality of included researches, and extracted data. Rev Man 5.2 was used for meta-analysis. Results A total of 23 studies including 7 randomized controlled trials and 16 case control studies were included in this study. Meta-analysis showed that there was statistically significant difference in case control studies related to anastomotic leakage between two groups [OR=0.39, 95%CI（0.30,0.50）, P0.01]. However, no statistical difference in anastomotic stricture was observed between the two groups [randomized controlled trials： RR=0.80, 95%CI（0.49,1.30）, P=0.36; case control studies： OR=0.64,95%CI（0.40,1.03）, P=0.07]. And there was no statistical difference in cardiac complications [randomized controlled trials： RR=0.70, 95%CI（0.46,1.06）, P=0.09; case control studies： OR=1.13, 95%CI（0.70,1.81）, P=0.62]. There was also no statistical difference in pulmonary complications[randomized controlled trials： RR=1.27, 95%CI（0.92,1.75）, P=0.14; case control studies： OR=0.91, 95%CI（0.66,1.27）, P=0.59]. Besides, there was also no statistical difference in postoperative mortality [randomized controlled trials： RR=0.47, 95%CI（0.19,1.16）, P=0.10; case control studies： OR=0.18, 95%CI（0.03,1.01）, P=0.05]. Conclusion For patients with esophageal carcinoma undergoing esophagectomy and reconstruction, the incidence of anastomotic leakage was significantly lower with posterior mediastinal route than that of retrosternal route.