全胃切除术后两种消化道重建术式疗效的Meta分析  

The Meta-analysis of the Postoperative Effect for Two Kinds of Digestive Reconstruction after Total Gastrectomy

作　　者：张中彦[1] 李涛[1] 许新才[1] 张文斌[1] 王云海[1] 李禾禾[1] 

机构地区：[1]新疆医科大学第一附属医院胃肠外科,乌鲁木齐830054

出　　处：《医学综述》2014年第22期4179-4182,共4页Medical Recapitulate

摘　　要：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。Objective To evaluate the clinical efficacy of functional jejunal interposition surgery（ FJI）and Roux-en-Y gastric surgery（ RY） after total gastrectomy. Methods A fully recursive literature search was conducted in Pub Med,Cochrane and Ovid electronic library controlled clinical trials database,Chinese Biomedical Literature Database（ CBM）,China National Knowledge Infrastructure（ CNKI） and Chinese Wanfang Medical Literature Database from Jan. 2000 to Jan. 2013. Retrieval languages is not restricted.Randomized or quasirandomized controlled trials of the efficacy of FJI and RY surgery were considered for inclusion. The reflux esophagitis,dumping syndrome,diarrhea and patient＇s hemoglobin,weight after surgery of two surgery approaches were observed. Data related to clinical outcomes were extracted by two reviewers independently. Meta-analysis was performed by Rev Man 5. 2 software. Results Nine published reports of eligible studies involving 703 participants met the inclusion criteria. The result of meta-analysis showed that：compared with RY surgery,FJI surgery had significant differences in the incidence of postoperative reflux esophagitis[OR = 0. 20,95% CI（ 0. 11,0. 35）,P〈0. 01 ],postoperative dumping syndrome[OR = 0. 25,95% CI（ 0. 13,0. 49）,P〈0. 01]and patient＇s hemoglobin[MD = 4. 34,95% CI（ 0. 14,8. 54）,P = 0. 04],weight[MD = 6. 33,95% CI（ 4. 36,8. 30）,P〈0. 01] after surgery. However,there were no significant differences between the two groups in the incidence of diarrhea after surgery[OR = 0. 45,95% CI（ 0. 17,1. 17）,P = 0. 10]. Conclusion In postoperative complications and nutritional status,FJI surgery is better than RY gastric surgery. FJI is a more reasonable way of digestive tract reconstruction.

关 键 词：胃肠外科手术 间置空肠 功能性间质空肠代胃术 Roux-en-Y 系统评价 META分析 

分 类 号：R619.9[医药卫生—外科学]