食管癌根治术后应用网膜包裹吻合口荟萃分析

Omentoplasty of the anastomosis after esophagectomy: A meta-analysis

目的比较食管癌根治术后网膜包裹吻合口对于预防术后吻合口瘘的疗效,并探讨网膜成形术的安全性。方法在Medline、EMBASE和Cochrane图书馆3个数据库进行文献检索,选择比较食管癌根治术后使用网膜包裹吻合口与未行网膜包裹吻合口的疗效比较的研究。对吻合口瘘、吻合口狭窄、住院病死率和住院时间进行萃取分析,结果数据以比值(OR)、加权均数差(WMD)或相对风险(RR)报告,同时报告了95%的置信区间(95%CI)。结果共纳入6项研究,涉及1 608名患者。与未行网膜包裹组(对照组)比较,网膜包裹组吻合口瘘的发生率显著降低(OR=0.37,95%CI:0.23~0.60,P<0.001),住院时间显著缩短(WMD=-2.13,95%CI:3.57~0.69,P=0.004);但两组间吻合口狭窄发生率和院内病死率比较,差异无统计学意义(OR=0.82,95%CI:0.37~1.80,P=0.61;OR=0.61,95%CI:0.25~1.51,P=0.29)。结论食管癌根治术后使用大网膜包裹吻合口是一种安全、有效地预防吻合口瘘的方法。

Objective To compare the efficacy of omentoplasty with non-omentoplasty in the prevention of postoperative anastomotic leakage,and to investigate the safety of omentoplasty.Methods Bibliographic retrieval was performed on Medline,EMBASE and Cochrane Library databases to select studies that compared the efficacy of omentoplasty and non-omentoplasty after esophagectomy.A meta-analysis was performed on anastomotic leakage,anastomotic stenosis,hospital mortality,and length of hospital stay.Results were reported as odds ratio(OR),weighted mean difference(WMD),or relative risk(RR),with 95%confidence intervals.Results Six studies was found involving a total of 1608 patients.Compared with the non-omentoplasty group,the incidence of anastomotic leakage in the omentoplasty group(OR=0.37,95%CI:0.23-0.60,P<0.0001)was significantly reduced and the length of hospital stay(WMD=2.13,95%CI:3.57-0.69,P=0.004)was significantly shortened.However,there was no significant difference in the incidence of anastomotic strictures(OR=0.82,95%CI:0.37-1.80,P=0.61)or in-hospital mortality(OR=0.61,95%CI:0.25-1.51,P=0.29).Conclusions Omentoplasty after esophagectomy is a safe and effective method to prevent anastomotic leakage.