全胃切除后间置空肠代胃与Roux-en-Y吻合两种消化道重建方式远期并发症及生活质量比较的Meta分析  

Meta-analysis on comparison of long-term complications and quality of life between two digestive tract reconstruction techniques following total gastrectomy

作　　者：康悦[1] 魏玉哲[2] 薛英威[2] 

机构地区：[1]哈尔滨医科大学附属第二医院普通外三科,150040 [2]哈尔滨医科大学附属第三医院胃肠外科

出　　处：《中华胃肠外科杂志》2013年第2期135-139,共5页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的比较胃癌全胃切除后间置空肠代胃术与Roux—en—Y吻合两种消化道重建方式术后远期并发症及患者的生活质量，为全胃切除后消化道重建方式的选择提供循证医学依据。方法由两名研究者以“Gastrectomy”、“Roux-en—Y”和“Interposition”以及“全胃切除”、“间置空肠”为主题词和关键词检索PubMed、EMBASE、Cochrane、Library和GoogleScholer等英文数据库和中文期刊全文数据库、中国生物医学文献数据库等，对纳入的研究文献进行数据提取并核对，采用RevMan5．0软件进行数据处理。结果共纳入10篇文献计1628例胃癌全胃切除病例，其中消化道重建采用间置空肠代胃术728例，采用Roux-en-Y吻合术954例。与Roux-en—Y吻合术相比，间置空肠代胃术有助于降低患者的倾倒综合征发生率（OR=O．19，95％CI：0．11-0．34，P〈O．01）、提高预后营养指数（WMD=6．02，95％C／：1．82．10．22，P〈0．01）并改善术后体质量减轻程度（WMD=-2．45，95％C／：-3．81—1．71，P〈0．01），而两者在手术时间、住院时间及反流性食管炎发生率方面的差异则无统计学意义（均P〉0．05）。结论与Roux-en-Y吻合术相比，全胃切除后采用间置空肠代胃术进行消化道重建的胃癌患者，术后远期并发症发生率低，生活质量改善明显。Objective To compare the incidence of postoperative long-term complications and quality of life between two digestive tract reconstruction techniques after total gastrectomy in order to provide evidence for clinical practice. Methods A systematic literature search was carried out to obtain studies of randomized controlled trials （RCTs） of reconstruction techniques including jejunal interposition and Roux-en-Y. Data extracted from RCTs for meta-analysis were independently assessed by two reviewers. A meta-analysis was performed by RevMan5.0 software. Results A total of 1628 gastric cancer cases undergoing total gastrectomy from 10 RCTs were eligible for inclusion, among whom 728 received jejunal interposition reconstruction and 954 Roux-en-Y anastomosis. As compared with Roux-en-Y anastomosis, jejunal interposition reconstruction significantly decreased the incidence of dumping syndrome （OR =0.19, 95% CI：0.11-0.34, P〈0.01 ）, increased the prognostic nutritional index （WMD=6.02, 95%C1：1.82-10.22, P〈0.01）, and improved the body weight postoperatively （WMD=-2.45, 95%CI： -3.81--1.71 ,P〈0.01）. Meanwhile, jejurial interposition reconstruction did not prolong operative time and hospital stay （both P〉0.05）. Conclusion Jejunal interposition has better efficacy t7han Roux-en-Y in dumping syndrome and quality of life, and is a reasonable and effective digestive tract reconstruction for long-term survival of gastric cancer patients.

关 键 词：胃肿瘤 全胃切除术 消化道重建 间置空肠代胃 Roux-en—Y吻合 META分析 

分 类 号：R735.2[医药卫生—肿瘤]