胃远端大部切除术后Billroth-Ⅰ与Roux-en-Y吻合消化道重建的围手术期安全性及中远期并发症的meta分析

Comparison of perioperative safety and middle-long term complications of Roux-en-Y and Billroth-Ⅰ reconstructions after distal subtotal gastrectomy:a meta-analysis

目的采用meta分析的方法,评价胃远端大部切除术后消化道重建中Billroth-Ⅰ吻合及Roux-en-Y吻合方式的围手术期安全性及中远期并发症。方法通过Embase、Pub Med、Med Line及The Cochrane Library数据库检索关于胃远端大部切除术后消化道重建中采用Billroth-Ⅰ吻合及Roux-en-Y吻合方式的随机对照试验(RCT)文献。检索开始于2015年12月1日,截止至2016年3月1日。根据制定的纳入和排除标准对检索到的文献进行筛选,采用改良Jadad量表对纳入研究的文献进行质量评价,采用Review Manager Version 5.1软件对数据进行meta分析。结果共纳入5篇RCT文献共600例患者,其中采用Roux-en-Y吻合的患者302例,采用Billroth-Ⅰ吻合的患者298例。meta分析结果提示:Billroth-Ⅰ吻合在手术时间〔WMD:38.95;95%CI:(19.86,58.04);P<0.000 1〕和术中出血量〔WMD:34.85;95%CI:(2.13,67.56);P=0.04〕方面较Roux-en-Y吻合有一定的优势,但是行Roux-en-Y吻合的患者在预防胆汁返流〔OR:0.03;95%CI:(0.01,0.11);P<0.000 01〕和残胃炎〔OR:0.37;95%CI:(0.25,0.54);P<0.000 01〕方面效果更好。在住院时间〔WMD:2.96;95%CI:(–0.00,5.93);P=0.05〕、吻合口漏〔OR:0.43;95%CI:(0.11,1.68);P=0.23〕、吻合口狭窄〔OR:1.84;95%CI:(0.61,5.53);P=0.27〕、返流性食管炎〔OR:0.63;95%CI:(0.28,1.44);P=0.27)及胃排空障碍〔OR:1.24;95%CI:(0.46,3.30);P=0.67〕方面Billroth-Ⅰ吻合及Roux-en-Y吻合比较差异均无统计学意义。结论 Billroth-Ⅰ吻合及Roux-en-Y吻合术式各有优缺点,Billroth-Ⅰ吻合在安全性方面更优,而Roux-en-Y吻合对于提高患者生活质量方面更优,但仍需要更多高质量的、设计精良、数据充足的RCT文献进行进一步验证。

Objective To systematically review perioperative safety and middle-term and long-term complications of Roux-en-Y anastomosis and Billroth-Ⅰ anastomosis after distal subtotal gastrectomy by a meta-analysis. Methods Literatures about Roux-en-Y and Billroth- - anastomoses after distal subtotal gastrectomy in Embase, PubMed, MedLine, and the Cochrane Library databases were searched. Retrieval time was from December 1, 2015 to March 1, 2016. According to the inclusion and exclusion criteria, two reviewers independently screened literatures, extracted data, and evaluated the qualities of the included studies. Then meta-analysis was performed using Review Manager Version 5.1 software. Results Five randomized controlled trials （RCTs） were finally included involving 600 patients, of which 302 patients were underwent Roux-en-Y anasomosis, 298 patients were underwent Billroth-Ⅰ anasomosis. The results of meta-analysis showed that the Billroth-Ⅰ anastomosis operation had more advantages in the operative time I WMD： 38.95; 95% CI： （19.86, 58.04）; P〈0.000 1） and the intraoperative bleeding I WMD： 34.85; 95% CI： （2.13, 67.56）; P=0.04） . However, the Roux-en-Y anastomosis had more significant effects in the prevention of bile reflux I OR： 0.03; 95% CI： （0.01, 0.11）; P〈0.000 01 / and the residual gastritis （OR： 0.37; 95% CI： （0.25, 0.54）; P〈0.000 01/ . There were no differences in the hospital stay （ WMD： 2.96; 95% CI： （-0.00, 5.93）; P=0.05） , anastomotic leakage （OR： 0.43; 95% CI： （0.11, 1.68）; P=0.23） , anastomotic stricture IOR： 1.84; 95% CI： （0.61, 5.53）; P=0.27/ , reflux esophagitis I OR： 0.63; 95% CI： （0.28, 1.44）; P=0.271 , and delayed gastric emptying （ OR： 1.24; 95% C1： （0.46, 3.30）; P=0.67） between the Roux-en-Y anastomosis and Billroth-Ⅰ anastomosis. Conclusions Billroth-Ⅰ anastomosis and Roux-en-Y anastomosis have their own advantages and disadvantages, in term of safety of Billroth-Ⅰ anastomosis is better, but it＇s quality of life is worse as compared with Roux-en-Y anastomosis. However, more high-quality, well-designed, adequate RCTs data are needed to validate.