管状胃与全胃重建食管治疗食管癌疗效的系统评价与Meta分析

Clinical effect of tubular stomach and whole stomach reconstruction on esophageal carcinoma treatment:A systematic review and meta-analysis

目的系统评价食管癌根治术中管状胃与全胃重建食管的疗效。方法检索PubMed、Web of Science、The Cochrane Library、EMbase、CNKI、Wanfang Data、VIP和CBM数据库,收集比较管状胃和全胃食管重建术治疗食管癌临床效果的随机对照研究,检索时间均为建库至2019年5月。采用RevMan 5.3软件进行Meta分析。结果纳入29个随机对照研究,共3012例患者,文献质量评价显示文章质量均为良好。Meta分析结果显示,与全胃代食管组相比,管状胃组的吻合口瘘[RR=0.64,95%CI(0.50,0.83),P=0.0006]、吻合口狭窄[RR=0.65,95%CI(0.50,0.86),P=0.002]、胸胃综合征[RR=0.19,95%CI(0.13,0.27),P<0.001]、反流性食管炎[RR=0.23,95%CI(0.19,0.30),P<0.001]、胃排空障碍[RR=0.39,95%CI(0.27,0.57),P<0.001]和肺部感染[RR=0.44,95%CI(0.31,0.62),P<0.001]等术后并发症均明显减少,术后6个月和1年的生活质量评分和满意度更高(P<0.05)。在术中出血量和术后住院时间方面,管状胃也比全胃更好(P<0.05)。但在手术时间,术后胃肠减压时间,术后闭式引流时间,术后1年、2年、3年生存率,术后3周和3个月的生活质量评分以及术后3周生活满意度方面,两组差异均无统计学意义(P>0.05)。结论管状胃比全胃在食管癌根治术的安全性与有效性方面更有优势。

Objective To systematically evaluate the efficacy of tubular stomach and whole stomach reconstruction in the treatment of esophageal cancer.Methods We searched PubMed,Web of Science,The Cochrane Library,EMbase,CNKI,Wanfang Data,VIP and CBM databases to collect the randomized controlled trial(RCT)studies on the efficacy comparison between tubular stomach and total gastric reconstruction of esophagus in esophagectomy from their date of inception to May 2019.Then meta-analysis was performed by using RevMan 5.3 software.Results A total of Twenty-nine RCTs were included,and 3012 patients were involved.The results of meta-analysis showed that the postoperative complications such as anastomotic fistula[RR=0.64,95%CI(0.50,0.83),P=0.0006],anastomotic stenosis[RR=0.65,95%CI(0.50,0.86),P=0.002],thoracic gastric syndrome[RR=0.19,95%CI(0.13,0.27),P<0.001],reflux esophagitis[RR=0.23,95%CI(0.19,0.30),P<0.001],gastric emptying disorder[RR=0.39,95%CI(0.27,0.57),P<0.001]and pulmonary infection[RR=0.44,95%CI(0.31,0.62),P<0.001]were significantly reduced,and the postoperative quality of life score and satisfaction were higher at 6 months and 1 year in the tubular stomach group(P<0.05).In terms of intraoperative blood loss and postoperative hospital stay,they were better in the tubular stomach group than those in the whole stomach group(P<0.05).However,there was no statistically significant difference between the two groups in operation time,postoperative gastrointestinal decompression time,postoperative closed drainage time,postoperative 1-year,2-year and 3-year survival rate,postoperative quality of life score at 3 weeks and 3 months,and postoperative life satisfaction at 3 weeks.Conclusion The tubular stomach is more advantageous than the whole stomach in the reconstruction of esophagus after esophagectomy.