食管切除后食管胃器械吻合与手工吻合疗效的Meta分析

Comparison of esophagogastric anastomosis by stapled versus hand-sewn—A Meta-analysis

目的:系统评价食管切除术后食管胃器械吻合与手工吻合的临床安全性和疗效。方法:计算机检索Pub Med、EMbase、The Cochrane Library(2015年第11期)、Web of Science、CBM、CNKI、VIP和Wan Fang Data。检索时限均为各数据库建库至2015年11月30日,收集器械吻合与手工吻合对食管胃吻合术后吻合口并发症影响的相关的随机对照试验(RCT),按照纳入排除标准筛选文献,对符合标准的RCT由2位研究者独立进行资料提取和质量评价后,采用Rev Man 5.3软件进行Meta分析。结果:纳入19个RCT共2 558例。Meta分析显示:与手工吻合相比,器械吻合减少了手术时间[MD=-20.75,95%CI(-31.42,-10.07),P=0.000 1],减少了吻合时间[MD=-14.91,95%CI(-28.10,-1.72),P=0.03],减少了术中出血量[MD=-12.66,95%CI(-23.91,-1.41),P=0.03];但在术后吻合口瘘发生率[RR=0.77,95%CI(0.57,1.04),P=0.09],吻合口狭窄发生率[RR=1.44,95%CI(0.95,2.19),P=0.09],胃食管反流发生率[RR=1.21,95%CI(0.86,1.69),P=0.28],术后死亡率[RR=1.15,95%CI(0.79,1.66),P=0.47],肺部并发症发生率[RR=1.14,95%CI(0.92,1.43),P=0.24]和术后住院时间[MD=-2.73,95%CI(-6.76,1.30),P=0.18]等方面,二者差异无统计学意义。结论:与手工吻合相比较,器械吻合可以减少手术时间、吻合时间及术中出血量,但对食管胃吻合术后吻合口瘘、吻合口狭窄、胃食管反流、术后死亡率、肺部并发症的发生率以及术后住院时间无显著影响。

Objective： To compare the clinical efficiency and safety of stapled versus hand- sewn esophagogastric anastomosis after esophageal ressection. Methods： We searched Pub Med,EMbase,Cochrane Library（ Issue 11 2015）,Web of Knowledge,CNKI,CBM,Wan Fang Data and VIP up to November 2015. Randomized controlled trials involving the treatment outcome after stapled versus hand- sewn esophagogastric anastomosis were included. Data were extracted and methodological quality was evaluated by two reviewers independently with a designed extraction form. Then Rev Man 5. 3 software was used for Meta- analysis. Results： A total of 19 studies involving 2 558 patients were included. The results of Meta- analysis showed that comparing with hand- sewn esophagogastric anastomosis,stapled esophagogastric anastomosis could reduce the duration of operation[MD =- 20. 75,95% CI（- 31. 42,- 10. 07）,P= 0. 000 1],the duration of anastomosi[MD =- 14. 91,95% CI（- 28. 10,- 1. 72）,P = 0. 03] and blood loss[MD=- 12. 66,95% CI（- 23. 91,- 1. 41）,P = 0. 03]. There was no statistical difference between the incidences of postoperative anasotmostic leaks[RR = 0. 77,95% CI（ 0. 57,1. 04）,P = 0. 09 ],anastomotic stricture[RR = 1. 44,95% CI（ 0. 95,2. 19）,P = 0. 09],stroesophageal reflux[RR = 1. 21,95% CI（ 0. 86,1. 69）,P = 0. 28],mortality[RR= 1. 15,95% CI（ 0. 79,1. 66）,P = 0. 47],pulmonary complication[RR = 1. 14,95% CI（ 0. 92,1. 43）,P = 0. 24]or hospital stay[MD =- 2. 73,95% CI（- 6. 76,1. 30）,P = 0. 18]. Conclusion： Comparing with hand- sewn esophagogastric anastomosis,stapled esophagogastric anastomosis could reduce the duration of operation,the duration of anastomosis and blood loss,but there was no statistically difference between anastomostic leak,anastomotic stricture,stroesophageal reflux,mortality,pulmonary complication or hospital stay.