管状胃与全胃相比较行消化道重建的Meta分析

摘要

BACKGROUND:Over the past 10 years, scholars have proposed the tubular stomach as an alternative to the whole stomach for digestive tract reconstruction; however, its occurrence rate of postoperative complications has been controversial. OBJECTIVE:To evaluate the clinical efficacy of tubular stomach versus whole stomach for digestive tract reconstruction in the resection of esophageal carcinoma. METHODS: The randomized controled trials about tubular stomach for digestive tract reconstruction in the resection of esophageal carcinoma were searched from PubMed, OVID, CNKI, EBSCO, Science online, Wangfang, Super Star Digital Library, CMB, Baidu and Google search engines. Two searchers screened studies based on the included criteria strictly. Literature quality and bias risk were assessed according to the criteria of Cochrane Colaboration, GRADEprofiler3.6.1 software was used for evaluation of the quality grade, and Revman5.3 for data management and statistical analysis. RESULTS AND CONCLUSION:Totaly 12 randomized controled trials including 4 137 patients were enroled. Compared with the whole stomach group, in the tubular stomach group, the incidences of reflux esophagitis and thoracic stomach syndrome were significantly lower, but there was no difference in the incidences of anastomotic leakage and anastomotic stenosis between the two groups. These findings indicate that the tubular stomach as a substitute of the whole stomach for digestive tract reconstruction in the resection of esophageal carcinoma is a safe and effective. However, the literatures included are only in English and Chinese, and there is publication bias and smal sample size. Therefore, the large-sample high-quality clinical randomized controled trials are stil needed for further confirmation.%背景：近10年来国内外学者提出了管状胃替代食管行消化道重建的方法，然而其术后并发症的发生率却一直存在争议。目的：评价食管癌根治术中管状胃代全胃行消化道重建的临床疗效。方法：计算机检索PubMed、OVID、CNKI、EBSCO、Science online、万方、超星数字图书馆、中国生物医学文献数据库(CMB)、以及百度和 Google 搜索引擎，关于食管癌根治术中以管状胃行消化道重建的临床RCT，由两名研究者严格按照纳入标准进行文献筛选，依据 Cochrane 协助网提供的标准评价文献质量及偏倚风险，采用GRADEprofiler 3.6.1软件评价文献的质量等级，采用Revman5.3软件对数据进行管理和统计分析。结果与结论：共纳入12篇文献共4137例患者，合并效应量结果表明管状胃组与全胃组相比较，吻合口瘘发生率、吻合口狭窄发生率两组差异无显著性意义，反流性食管炎发生率及胸胃综合征发生率管状胃组显著少于全胃组。结果表明，管状胃代全胃在食管癌根治术中行消化道重建是一种安全、有效的方法。但是由于纳入的文献仅为英文和中文文献，存在发表偏倚，个别文献样本量较小，尚需大样本高质量的临床RCT试验进一步验证。