AIM:To compare the clinical outcomes between jejunal interposition reconstruction and Roux-en-Y anastomosis after total gastrostomy in patients with gastric cancer.METHODS:A systematic literature search was conducted ...AIM:To compare the clinical outcomes between jejunal interposition reconstruction and Roux-en-Y anastomosis after total gastrostomy in patients with gastric cancer.METHODS:A systematic literature search was conducted by two independent researchers on Pub Med,EMBASE,the Cochrane Library,Google Scholar,and other English literature databases,as well as the Chinese Academic Journal,Chinese Biomedical Literature Database,and other Chinese literature databases using "Gastrostomy","Roux-en-Y",and "Interposition" as keywords.Data extraction and verification were performed on the literature included in this study.Rev Man 5.2 software was used for data processing.A fixed-effects model was applied in the absence of heterogeneity between studies.A random effects model was applied in the presence of heterogeneity between studies.RESULTS:Ten studies with a total of 762 gastric cancer patients who underwent total gastrostomy were included in this study.Among them,357 received jejunal interposition reconstruction after total gastrostomy,and 405 received Roux-en-Y anastomosis.Compared with Roux-en-Y anastomosis,jejunal interposition reconstruction significantly decreased the incidence of dumping syndrome(OR = 0.18,95%CI:0.10-0.31;P < 0.001),increased the prognostic nutritional index [weighted mean difference(WMD) = 6.02,95%CI:1.82-10.22;P < 0.001],and improved the degree of postoperative weight loss [WMD = 2.47,95%CI:-3.19-(-1.75);P < 0.001].However,there is no statistically significant difference in operative time,hospital stay,or incidence of reflux esophagitis.CONCLUSION:Compared with Roux-en-Y anastomosis,patients who underwent jejunal interposition reconstruction after total gastrostomy had a lower risk of postoperative long-term complications and improvedlife quality.展开更多
文摘AIM:To compare the clinical outcomes between jejunal interposition reconstruction and Roux-en-Y anastomosis after total gastrostomy in patients with gastric cancer.METHODS:A systematic literature search was conducted by two independent researchers on Pub Med,EMBASE,the Cochrane Library,Google Scholar,and other English literature databases,as well as the Chinese Academic Journal,Chinese Biomedical Literature Database,and other Chinese literature databases using "Gastrostomy","Roux-en-Y",and "Interposition" as keywords.Data extraction and verification were performed on the literature included in this study.Rev Man 5.2 software was used for data processing.A fixed-effects model was applied in the absence of heterogeneity between studies.A random effects model was applied in the presence of heterogeneity between studies.RESULTS:Ten studies with a total of 762 gastric cancer patients who underwent total gastrostomy were included in this study.Among them,357 received jejunal interposition reconstruction after total gastrostomy,and 405 received Roux-en-Y anastomosis.Compared with Roux-en-Y anastomosis,jejunal interposition reconstruction significantly decreased the incidence of dumping syndrome(OR = 0.18,95%CI:0.10-0.31;P < 0.001),increased the prognostic nutritional index [weighted mean difference(WMD) = 6.02,95%CI:1.82-10.22;P < 0.001],and improved the degree of postoperative weight loss [WMD = 2.47,95%CI:-3.19-(-1.75);P < 0.001].However,there is no statistically significant difference in operative time,hospital stay,or incidence of reflux esophagitis.CONCLUSION:Compared with Roux-en-Y anastomosis,patients who underwent jejunal interposition reconstruction after total gastrostomy had a lower risk of postoperative long-term complications and improvedlife quality.
文摘目的评价全胃切除术后功能性间质空肠代胃术(FJI)与食管空肠Roux-en-Y代胃术(RY)的临床疗效。方法计算机检索2000年1月至2013年1月的Pub Med、Cochrane、Ovid电子图书馆临床对照试验资料库、中国生物医学文献数据库(CBM)、中国学术期刊网全文数据库(CNKI)和中国万方医学网文献数据库。检索语种不限。纳入比较FJI与食管空肠RY术后疗效的随机或半随机对照试验,并观察两种手术的术后反流性食管炎、腹泻、倾倒综合征的发生率,以及患者血红蛋白、体质量等营养状况的变化。由2名评价员独立评价并核对研究质量。采用Rev Man 5.2版软件进行统计分析。结果共9个随机对照试验703例患者纳入研究。Meta分析结果显示:FJI与RY相比较,两者在术后反流性食管炎发生率[OR=0.20,95%CI(0.11,0.35),P<0.01]、倾倒综合征发生率[OR=0.25,95%CI(0.13,0.49),P<0.01]、患者术后血红蛋白[MD=4.34,95%CI(0.14,8.54),P=0.04]、体质量[MD=6.33,95%CI(4.36,8.30),P<0.01]方面比较差异有统计学意义,但两者在术后腹泻发生率[OR=0.45,95%CI(0.17,1.17),P=0.10]比较差异无统计学意义。结论 FJI较RY在术后并发症、患者营养状况方面更佳,是一种更为合理的消化道重建方式。
