Ivor Lewis和Sweet术式治疗食管癌疗效及安全性的Meta分析

Efficacy and safety of Ivor Lewis and Sweet in the treatment of esophageal cancer:A Meta-analysis

目的:探讨食管癌切除术Ivor Lewis和Sweet两种术式的临床治疗效果及心肺保护作用。方法:检索PubMed、Web of Science、The Cochrane Library、EMBASE、CNKI、Wanfang Data、VIP和CBM数据库,最终纳入24篇文献,其中包括21篇病例对照研究、3篇随机对照研究(RCT),总共包含5082例患者,其中行Ivor Lewis术式患者2241例,行Sweet术式患者2841例。采用RevMan5.3进行Meta分析。结果:术后心血管并发症发生率Meta分析结果得出[OR=0.50,95%CI(0.25,1.01),P=0.05],差异有统计学意义。术后肺部并发症发生率Meta分析结果得出[OR=0.69,95%CI(0.48,0.99),P=0.04],差异有统计学意义。术后吻合口瘘发生率Meta分析结果得出[OR=0.83,95%CI(0.51,1.35),P=0.45],差异无统计学意义。术后喉返神经损伤发生率Meta分析结果得出[OR=1.57,95%CI(0.75,3.27),P=0.23],差异无统计学意义。3年生存率Meta分析结果得出[OR=1.91,95%CI(1.29,2.81),P=0.001],Ivor Lewis组患者术后3年生存率高于Sweet组,差异有统计学意义。手术时间Meta分析结果得出[MD=30.61,95%CI(14.48,46.74),P=0.0002],差异有统计学意义。淋巴结清扫数目Meta分析结果得出[MD=5.81,95%CI(4.63,6.99),P<0.001],差异有统计学意义。术中出血量Meta分析结果得出[MD=4.54,95%CI(-4.54,13.63),P=0.33],差异无统计学意义。术后住院天数Meta分析结果得出[MD=-0.59,95%CI(-1.80,0.61),P=0.33],差异无统计学意义。结论:与Sweet手术相比,Ivor Lewis手术在淋巴结清扫、心肺并发症发生率以及生存率方面有较大优势。而在手术时间方面,传统Sweet手术更具优势。

Objective:To explore the clinical therapeutic effect and cardiopulmonary protective effect of the resection of esophageal cancer with Ivor Lewis and Sweet.Methods:the PubMed,Web of Science,The Cochrane Library,EMBASE,CNKI,Wanfang Data,VIP and CBM databases were searched.A total of 24 literatures were included,and 5082 patients were collected,including 2241 patients with Ivor Lewis operation and 2841 patients with Sweet operation.RevMan 5.3 was used for Meta-analysis.Results:According to the results of Meta-analysis of the incidence of postoperative cardiovascular complications[OR=0.50,95%CI(0.25,1.01),P=0.05],the difference was statistically significant.According to the results of Meta-analysis of the incidence of postoperative pulmonary complications[OR=0.69,95%CI(0.48,0.99),P=0.04],the difference was statistically significant.There was no significant difference in the incidence of anastomotic leakage[OR=0.83,95%CI(0.51,1.35),P=0.45].There was no significant difference in the incidence of recurrent laryngeal nerve injury[OR=1.57,95%CI(0.75,3.27),P=0.23].Meta-analysis of 3-year survival rate showed that[OR=1.91,95%CI(1.29,2.81),P=0.001]the 3-year survival rate of Ivor Lewis group was higher than that of Sweet group.Meta-analysis of operation time showed that[MD=30.61,95%CI(14.48,46.74),P=0.0002]was statistically significant.The results of Meta-analysis of the number of lymph nodes dissected showed that[MD=5.81,95%CI(4.63,6.99),P<0.001]was statistically significant.There was no significant difference in intraoperative blood loss[MD=4.54,95%CI(-4.54,13.63),P=0.33]between the two groups.There was no significant difference in postoperative hospitalization days[MD=-0.59,95%CI(-1.80,0.61),P=0.33]between the two groups.Conclusion:Compared with Sweet operation,Ivor Lewis operation has more advantages in lymph node dissection,cardiopulmonary complications and survival rate.In terms of operation time,traditional Sweet operation has more advantages than Ivor Lewis.