全胃切除后食管空肠手工缝合与器械吻合比较的Meta分析

Meta-analysis of manual suture versus mechanical anastomosis in esophagojejunostomy after total gastrectomy

目的:系统评价腹腔镜下全胃切除后消化道重建的两种方式(食管空肠手工缝合与器械吻合)。方法:以“全胃切除和手工缝合”为关键词,计算机检索PubMed、CBM、万方数据库、中国知网等数据库中有关手工缝合和器械吻合的临床研究,年限从2015年1月至2020年10月,纳入符合标准的文献,评价质量,提取数据,采用Review Manager 5.4软件进行Meta分析。结果:最终纳入4篇临床研究,共746例患者。Meta分析结果提示,手工缝合组与器械吻合组手术时长差异无统计学意义[ MD=8.32,95% CI(-5.94,22.57), P>0.05];手工缝合组的术中出血量少于器械吻合组[ MD=-9.54,95% CI(-15.54,-3.55), P<0.05];手工缝合组术后排气时间早于器械吻合组[ MD=-0.38,95% CI(-0.59,-0.18), P<0.05];手工缝合组住院时间短于器械吻合组[ MD=-0.88,95% CI(-1.23,-0.54), P<0.05];手工缝合组术后吻合口瘘发生率低于器械吻合组[ OR=0.23,95% CI(0.06,0.93), P<0.05];手工缝合组术后吻合口狭窄发生率低于器械吻合组[ OR=0.14,95% CI(0.04,0.54), P<0.05]。 结论:全胃切除后,食管空肠吻合口在腹腔镜直视下,使用倒刺线连续缝合与使用器械吻合相比较更加安全、经济,同时缩短患者术后恢复和住院时间。

Objective To systematically evaluate manual suture versus mechanical anastomosis in esophagojejunostomy,two methods of digestive tract reconstruction after laparoscopic total gastrectomy.Methods A computer-based online search of PubMed,CBM,Wanfang database and CNKI database was performed to retrieve clinical studies related to manual suture(manual suture group)and mechanical anastomosis(mechanical anastomosis group)in esophagojejunostomy after laparoscopic total gastrectomy published between January 2015 and October 2020.The quality of eligible literature was evaluated and data were extracted for meta-analysis using Review Manager 5.4 software.Results Four clinical studies involving 746 patients were included in the final analysis.Meta-analysis results revealed that there was no significant difference in operative time between manual suture and mechanical anastomosis methods[MD=8.32,95%CI(-5.94,22.57),P>0.05].The intraoperative blood loss in manual suture group was significantly less than that in mechanical anastomosis group[MD=-9.54,95%CI(-15.54,-3.55),P<0.05].The time to exhaust in the manual suture group was shorter than that in the mechanical anastomosis group[MD=-0.38,95%CI(-0.59,-0.18),P<0.05].The length of hospital stay in the manual suture group was less than that in the mechanical anastomosis group[MD=-0.88,95%CI(-1.23,-0.54),P<0.05].The incidence of anastomotic leakage in the manual suture group was significantly lower than that in the mechanical anastomosis group[OR=0.23,95%CI(0.06,0.93),P<0.05].The incidence of anastomotic stenosis in the manual suture group was significantly lower than that in the mechanical anastomosis group[OR=0.14,95%CI(0.04,0.54),P<0.05].Conclusion After total gastrectomy,continuous suture of oesophago-jejuno ends with barbed threads under laparoscopy is safer and less expensive and needs less time to postoperative recovery and shorter length of hospital stay compared with mechanical anastomosis.