机械吻合与手工吻合对食管癌患者术后并发症影响的系统评价与Meta分析

Influence of Mechanical versus Hand-sewn Anastomosis on Surgical Complications of Patients with Esophageal Carcinoma after Esophagectomy:A Systematic Review and Meta-analysis

目的比较食管癌切除食管胃机械吻合与手工吻合术后并发症的发生率差异。方法计算机检索Medline(1960年1月至2015年6月)、EMbase(1980年1月至2015年6月)、Cochrane Library(1996年1月至2015年6月)、Web of Science(1980年1月至2015年6月),收集比较食管癌机械吻合和手工吻合对术后并发症发生率差异的随机对照试验(randomized controlled trial,RCT),并用Google Scholar等搜索引擎搜索参考文献。按照纳入和排除标准筛选后提取数据,采用Stata12.0软件进行Meta分析,用GRADE profiler 3.6软件进行证据质量评价。结果最终纳入14个RCT,包含1 611例患者。Meta分析结果显示,机械吻合组吻合口瘘发生率与手工吻合组差异无统计学意义[RR=1.07,95%CI(0.76,1.51),P=0.699],但吻合口狭窄的发生率要高于手工吻合组,差异有统计学意义[RR=1.59,95%CI(1.21,2.09),P=0.001]。结论机械吻合相对手工吻合对于食管癌术后吻合口瘘的发生率没有明显改善,而且会增加吻合口狭窄的发生率,临床医生要根据患者情况,慎重选择。

Objective To compare the complication morbidity of mechanical and hand-sewn esophagogastric anastomosis systemically. Methods Medline（January 1960 to June 2015）,EMbase（January 1980 to June 2015）,Cochrane Library（January 1996 to June 2015）,Web of Science（January 1980 to June 2015） and other databases were searched to identify randomized controlled trials（RCTs） about comparing the complication morbidity of handsewn and mechanical anastomosis. Moreover,the references were searched by search engines such as Google Scholar. Papers were screened according to the inclusion and exclusion criteria. And then the data were extracted. The quality of current meta-analysis was assessed by GRADE profiler 3.6 software. The meta-analysis was conducted using Stata 12.0 software. Results A total of 1 611 patients in 14 RCTs were reviewed. The results suggested that the anastomatic leakage rate of mechanical method showed no significant difference from that of hand-sewn method [RR=1.07,95%CI（0.76,1.51）,P=0.699]. While the anastomatic stenosis rate was even higher [RR=1.59,95%CI（1.21,2.09）,P=0.001]. Conclusion Mechanical method can＇t reduce the anastomotic leakage rate following esophagogastrostomy,while it maybe increase the risk of anastomotic stenosis on the contrary. The patients＇ physical condition should be considered when surgeons make the choice.