抗反流手术与抑酸药物治疗胃食管反流病降低食管腺癌发生风险的meta分析

Comparison between Antireflux Surgery and Antacids for Gastroegsophageal Reflux Disease in the Prevention of Esophageal Adenocarcinoma: a Systematic Review and Meta-analysis

目的比较抗反流手术及药物治疗胃食管反流病(gastroesophageal reflux disease,GERD)对预防食管腺癌(esophagus adenocarcinoma,EAC)发生的效果。方法以esophagus、neoplasm、cancer、Barrett's esophagus、adenocarcinoma、fundoplication、antireflux surgery、Nissen等为英文检索词,以食道、良性肿瘤、癌、巴瑞特食管、腺癌、胃底折叠术抗反流手术、Nissen术式、胃食管反流病、质子泵抑制剂等为中文检索词,检索Pub Med、EMBASE、Cochrane library、Web of Science、万方、中国知网等数据库自建库至2017年4月,关于药物及手术治疗GERD的相关文献,设立纳入与排除标准筛选文献,并进行资料提取与偏倚评估。结果最终纳入文献7篇,其中3篇为随机对照试验(RCT)研究、4篇为回顾性病例对照研究,共纳入病例78 703例,其中手术治疗患者11 398例(手术组),药物治疗患者67 305例(药物组)。meta分析结果示:手术组与药物组患者相比,癌变率比较差异并无统计学意义(RR=1.10,95%CI:0.81,1.49,P=0.54);然而剔除病例数占比最大的研究后,药物组癌变率高于手术组(RR=0.38,95%CI:0.15,0.97,P=0.04)。结论对于GERD伴或不伴Barrett食管患者癌变率方面,抗反流手术优于药物治疗。但抗反流手术用于此类患者预防EAC的发生仍需进一步大样本、长期随访的RCT研究来验证。

Objective To compare the preventive effect of antireflux surgery and antacids in the treatment of gastroesophageal reflux disease(GERD)on esophageal adenocarcinoma(EAC).Methods A computerized literature search of multiple electronic databases was performed on PubMed,EMBASE,Cochrane Library,Web of science,Wanfang and CNKI database for related literature on drug and surgical treatment of GRED from an unbounded start date to 2017,using English terms such as esophagus,neoplasm,cancer,Barrett's esophagus,adenocarcinoma,fundoplication,antireflux surgery,Nissen,Gastroesophageal reflux disease,Proton pump inhibitors and Chinese equivalents.The inclusion and exclusion criteria were set up for quality evaluation,data extraction and bias assessment.Results Seven academic papers were included in the Meta-analysis,including three RCTs,four case-control studies with 78 703 cases,of which there were 11 398 cases who received antireflux surgery(surgerical treatment group)and 67 305 cases who received drug treatment(drug treatment group).The results of the Meta-analysis showed that there was no difference in canceration rate between surgical treatment group and drug treatment group(RR=1.10,95%CI:0.81,1.49,P=0.54).After the research of Ye were eliminated,and Meta-analysis showed that canceration rate in drug treatment group was higher than that in surgical treatment group(RR=0.38,95%CI:0.15,0.97,P=0.04).Conclusion In terms of canceration rate in patients with GERD with or without BE,antireflux surgery is superior to drug treatment.However,RCTS with larger sample size and long-term follow-up data are needed to confirm the role of antireflux surgery in the prevention of EAC.