胃上部癌行近端胃切除双通道吻合与全胃切除Roux-en-Y吻合临床疗效比较的meta分析

doi:10.3969/j.issn.1009-976X.2022.04.006

摘要/Abstract

摘要： 目的采用meta分析方法比较胃上部癌患者行近端胃切除双通道吻合（PG-DT组）与全胃切除Roux-en-Y吻合术（TG-RY组）的临床疗效。方法计算机检索Pubmed、Cochrane Library、Embase、中国知网,万方数据库、维普中文期刊网中关于胃上部癌行近端胃切除双通道吻合与全胃切除Roux-en-Y吻合研究报道。文献检索时限均从建库到2021年3月,由两名评价人员按照Cochrane系统评价手册5.1.0标准独立筛选文献,提取资料,分别应用Jadad量表及Newcastle-Ottawa Scale量表（NOS量表）对随机对照试验及观察性研究进行文献质量评价,使用RevMan 5.3软件分别对结局指标数据进行Meta分析,并对结果进行分析。结果共纳入16项研究,均为病例对照试验,共纳入1346例患者,其中PG-DT组589例,TG-RY组757例。Meta分析结果显示：PG-DT组较TG-RY组围手术期并发症发生率更少（OR=0.56,95%CI：0.39~0.79,P<0.001）,但严重并发症（OR=0.47,95%CI：0.2~1.08,P=0.08）发生率及吻合口瘘（OR=0.75,95%CI：0.4~1.39,P=0.35）发生率两组未见明显统计学差异。且与TG-RY组相比,PG-DT组在倾倒综合征（OR=0.21,95%CI：0.09~0.48,P<0.001）、反流性食管炎（OR=0.36,95%CI：0.21~0.65,P<0.001）等远期并发症的发生率更低,且术后1年的血红蛋白水平（MD=5.3,95%CI：3.18~7.42,P<0.001）、总蛋白（MD=1.74,95%CI：0.62~2.85,P<0.001）及白蛋白水平（MD=2.59,95%CI：0.9~4.28,P<0.001）均明显改善。PG-DT组较TG-RY组在手术时间、术中出血量方面的差异均无统计学意义（均P>0.05）,而PG-DT组比TG-RY组术中清扫淋巴结数目更少（MD=-7.35,95%CI：-8.55~-6.15,P<0.001）。结论胃上部癌行胃近端根治术联合食管-空肠与残胃-空肠双通道吻合术安全有效,可有效减少围手术期并发症以及倾倒综合征、反流性食管炎等远期并发症,并在一定程度上可改善术后营养状态。

关键词: 胃上部癌, 近端胃切除, 双通道重建, 全胃切除术

Abstract: Objective To compare the clinical efficacy of proximal gastrectomy with double tract anastomosis（PG-DT group） and total gastrectomy with Roux-en-Y anastomosis（TG-RY group） for upper gastric cancer using meta-analysis. Methods Pubmed, Embase, the Cochrane library, VIP and Wanfang database, CNKI were systematically searched for the research about proximal gastrectomy with double tract anastomosis（PG-DT group） and total gastrectomy with Roux-en-Y anastomosis（TG-RY group） for upper gastric cancer. The time limit for the retrieval of literature are set to from database building time to March 31, 2020. Information were extracted on the basis of the evaluation criteria of manual 5.1.0 Cochrane system by two evaluators independently,the quality of entrolled literatures was evaluated according to Jadad scale and Newcastle-Ottawa Scale, and RevMan 5.3 software are applied to perform a meta-analysis. Results A total of 16 studies with 1346 patients, all of the studies were case-control studies. There were 589 cases in PG-DT group,and 757 cases in TG-RY group. Meta-analysis showed that the incidence of perioperative complications was lower in PG-DT group than in TG-RY group（OR=0.56,95%CI:0.39~0.79, P<0.001）, However there was no significant statistical difference in the incidence of serious complications（OR=0.47,95%CI：0.2~1.08,P=0.08） and anastomotic leakage（OR=0.75,95%CI：0.4~1.39,P=0.35） between the two groups, Compared with TG-RY group,PG-DT group had a lower incidence of long-term complications such as dumping syndrome（OR=0.21,95%CI：0.09~0.48,P<0.001）and reflux esophagitis（OR=0.36,95%CI：0.21~0.65,P<0.001）.The hemoglobin（MD=5.3, 95%CI:3.18~7.42, P<0.001）, total protein（MD=1.74, 95%CI：0.62~2.85,P<0.001） and albumin levels（MD=2.59,95%CI：0.9~4.28,P=0.00） were significantly improved 1 year after surgery. There were no statistically significant difference in operative time and intraoperative blood loss between PG-DT group and TG-RY group（all P values >0.05）, However fewer lymph nodes were dissected in PG-DT group than in TG-RY group（MD=-7.35, 95%CI:-8.55~-6.15, P<0.001）. Conclusion Proximal gastrectomy with double tract anastomosis（PG-DT） is safe and effective for upper gastric cancer, it can effectively reduce perioperative complication,and it can also reduce long-term complications such as dumping syndrome and reflux esophagitis, and it can improve postoperative nutritional status to some extent.

Key words: gastric cancer, proximal gastrectomy, double tract, total gastrectomy

中图分类号:

R735.2

刘辉, 惠远见, 狄茂军, 刘焱伟, 李俊, 谭华勇. 胃上部癌行近端胃切除双通道吻合与全胃切除Roux-en-Y吻合临床疗效比较的meta分析[J]. 岭南现代临床外科, 2022, 22(04): 344-353.

LIU Hui, HUI Yuan-jian, DI Mao-jun, LIU Yan-wei, LI Jun, TAN Hua-yong. Meta-analysis on the clinical efficacy of proximal gastrectomy with double tract anastomosis and total gastrectomy with Roux-en-Y anastomosis for upper gastric cancer[J]. Lingnan Modern Clinics In Surgery, 2022, 22(04): 344-353.

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