Roux-en-Y型消化道重建在胃癌根治性远端胃大部切除术中应用的疗效与安全性的Meta分析

摘要

Objective To evaluate the safety and efficacy of Roux-en-Y reconstruction after distal gas-trectomy for patients with gastric cancer.Methods The articles including the keywords of ′gastric cancer′,′distal gastrectomy′,′Roux-en-Y′,′BillrothⅠ′were search in PubMed,MEDLINE,CNKI,CBM and WANG-FANG data base to select randomized controlled trials to be included in the study .The quality of the included studies was evaluated,and the qualified data was applied Meta-analysis by RevMan 5.2.Results Four ran-domized controlled trials were involved,including a total of 478 cases.Analysis results showed that Roux-en-Y reconstruction could reduce remnant gastritis[OR =0.43,95%CI 0.28-0.66,P =0.0001] and bile reflux[OR=0.04, 95%CI 0.01-0.14,P<0.0001], increase operation time[WMD 40.2,95%CI 13.93-66.11,P=0.003].But in length of hospital stay,anastomotic leakage,reflux esophagitis,there was no statis-tically significant difference(P>0.05).Conclusion Roux-en-Y reconstruction of digestive tract is superior to Billroth Ⅰ in reducing postoperative bile reflux and residual gastritis.%目的：评价 Roux-en-Y型消化道重建在胃癌根治性远端胃大部切除术中应用的疗效与安全性。方法以胃癌、远端胃大部切除、Roux-en-Y、BillrothⅠ等检索词检索 PubMed、MEDLINE、中国期刊全文数据库（CNKI）、中国生物文献数据库（CBM）、万方数据库，纳入随机对照试验（RCT），对文献进行质量评价，提取数据资料，应用 RevMan 5.2进行 Meta 分析。结果最终纳入4个 RCT，共478例患者。分析发现：Roux-en-Y型消化道重建可降低残胃炎（OR＝0.43，95％CI 0.28～0.66，P＝0.0001）和术后胆汁反流（OR＝0.04，95％CI 0.01～0.14，P＜0.0001），但会使手术时间延长（WMD 40.2，95％CI 13.93～66.11，P＝0.003）。 Roux-en-Y型、BillrothⅠ式在住院时间、吻合口瘘、反流性食管炎方面比较差异无统计学意义（ P＞0.05）。结论 Roux-en-Y型消化道重建在降低术后胆汁反流及残胃炎方面优于BillrothⅠ式。