胸腹腔镜联合Ivor Lewis术与McKeown术治疗胸中下段食管癌近期疗效的系统评价与Meta分析

The short-term outcomes of Ivor Lewis esophagectomy versus McKeown esophagectomy for thoracic middle-lower esophageal carcinoma:A systematic review and meta-analysis

目的比较胸腹腔镜胸中下段食管癌微创手术Ivor Lewis术式与Mc Keown术式的近期疗效,探讨食管癌微创切除术的最佳手术方式。方法计算机检索Pub Med、EMbase、The Cochrane Library、中国生物医学文献总库(CBM)、中国知网(CNKI)、万方数据库及维普数据库(VIP)公开发表的微创Ivor Lewis术式与微创Mc Keown术式的比较研究,检索时间均为数据库建库至2016年3月,采用Rev Man 5.3软件进行数据分析。结果 5篇文献共纳入870例食管癌手术患者,其中Ivor Lewis组416例,Mc Keown组454例。Newcastle Ottawa质量评分均在7~8分。Meta分析结果显示:相比较于Mc Keown组,Ivor Lewis组手术时间较短(WMD=–34.67,95%CI–53.70~–15.65,P=0.000 4),喉返神经损伤(OR=0.23,95%CI 0.12~0.44,P<0.000 01)、吻合口瘘(OR=0.24,95%CI 0.14~0.41,P<0.000 01),吻合口狭窄(OR=0.30,95%CI 0.16~0.55,P=0.000 01),肺部并发症(OR=0.25,95%CI0.15~0.43,P<0.000 01)发生率较低;在术中出血量、术后住院时间、住院费用、乳糜胸发生率方面两组差异无统计学意义(P>0.05);而Mc Keown组淋巴结清扫数目较多(WMD=–1.16,95%CI–2.00~–0.31,P=0.007)。结论在胸腹腔镜治疗胸中下段食管癌微创术式中,Ivor Lewis术式在近期疗效上较Mc Keown术式有一定优势,但Mc Keown术式清扫淋巴结数目更多。

Objective To compare the short-term outcomes between Ivor Lewis esophagectomy and McKeown esophagectomy under thoracoscopy and laparoscopy for thoracic middle-lower esophageal carcinoma and to investigate the optimal approach. Methods The relevant literatures （from database foundation to March 2016） comparing minimally invasive Ivor Lewis esophagectomy and minimally invasive McKeown esophagectomy were searched through PubMed, EMbase, The Cochrane Library, CBM, CNKI, Wanfang Data and VIP. RevMan 5.3 software was used for data analysis. Results A total of 870 patients in 5 studies were reviewed and data were pooled for analysis. The score of Newcastle Ottawa for the literatures was 7-8 points. The results showed that compared with the McKeown group, Ivor Lewis group had shorter operation time （WMD=-34.67, 95% CI -53.70 to -15.65, P=0.000 4）, less recurrent laryngeal nerve injuries （OR=0.23, 95% CI 0.12 to 0.44, P〈0.000 01）, anastomotic leakage （OR=0.24, 95% CI 0.14 to 0.41, P〈0.000 01）, anastomotic stenosis （OR=0.30, 95% CI 0.16 to 0.55, P=0.000 01）, and pulmonary complications （OR=0.25, 95% CI 0.15 to 0.43, P〈0.000 01）. There was no significant difference between the two groups in intraoperative blood loss, postoperative stay, hospitalization cost and chylothorax incidence. The McKeown group was associated with much more lymph nodes dissection （WMD=-I.16, 95% CI -2.00 to -0.31, P=0.007） than the Ivor Lewis group. Conclusion Compared with McKeown esophagectomy combined with thoracoscopy and laparoscopy, Ivor Lewis esophagectomy combined with thoracoscopy and laparoscopy has some advantages for thoracic middle-lower esophageal carcinoma, but a greater number of lymph nodes are dissected in McKeown procedure.