三角吻合术与毕Ⅰ吻合术在腹腔镜远端胃癌根治术中近期疗效对比的Meta分析  

Delta-shaped anastomosis versus Billroth Ⅰ anastomosis in laparoscopic radical resection of distal gastric cancer: a short-term efficacy meta-analysis

作　　者：王君辅[1] 谢勇[1] 胡林[1] 李昌荣[1] 李伟峰[1] 李红浪[1] 

机构地区：[1]南昌大学第二附属医院胃肠外科,江西南昌330006

出　　处：《中国内镜杂志》2015年第12期1270-1277,共8页China Journal of Endoscopy

摘　　要：目的系统评价三角吻合术(DA)与毕I吻合术(cBIA)在腹腔镜远端胃癌根治术中的近期疗效。方法由计算机检索PubMed、Medline、EMBASE、中国知网(CNKI)、万方等数据库,收集关于DA与cBIA在腹腔镜远端胃癌根治术疗效对比的临床对照试验。检索时限均为从建库至2015年4月1日。由2位研究者依据纳入、排除标准筛选文献、提取资料并质量评估分析后,采用Rev Man5.3版软件进行Meta分析。结果最终纳入9个同期临床对照试验,无随机对照实验,共计1 938例患者,Meta分析结果显示:与cBIA组相比,DA组术中出血量少(WMD=-24.75,95%CI:-42.41^-7.09,P=0.006);术后镇痛药物使用次数较少(WMD=-0.61,95%CI:-1.18^-0.03,P=0.040),进食时间早(WMD=-0.38,95%CI:-0.51^-0.24,P=0.000)。两组手术时间、肛门首次排气时间、住院时间、清扫淋巴结数目、总体并发症和吻合口相关并发症差异均无统计学意义(P>0.05)。结论胃三角吻合技术在腹腔镜远端胃癌根治术中安全可行,相比于毕I吻合术具有术中出血量少,术后疼痛减轻,加速患者胃肠道功能恢复等优点。【Objective】To evaluate the short-term efficacy of delta-shaped anastomosis（DA） and conventional Billroth I anastomosis（c BIA） in laparoscopic radical distal gastrectomy.【Methods】Clinical controlled trials about DA vs c BIA for laparoscopic radical distal gastrectomy were searched in Pub Med, Medline, EMBASE, CNKI, CBM and Wan Fang Data from the date of their establishment to May 2015. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed methodological quality of included studies. Meta-analysis was then conducted using Rev Man 5.3. 【Results】No randomized controlled trials were collected, and a total of 9 clinical concurrent controlled trials involving 1 938 patients were included finally.The results of meta-analysis showed that, compared with the c BIA, the DA group was lower in the intraoperative blood loss（WMD =-24.75, 95 % CI：-42.41 ^-7.09, P = 0.006）; and was less times of analgesic requirement（WMD =-0.61, 95 % CI：-1.18 ^-0.03, P = 0.040）; and was earlier beginning to take diet（WMD =-0.38, 95 %CI：-0.51 ^-0.24, P =0.000）; The operation time, postoperative first exhaust time, postoperative hospital stay,dissection number of lymph nodes, over complication and anantomosis-related complication were similar between the two groups（P〈0.05）. 【Conclusion】 The DA is a safe and feasible procedure for totally laparoscopic distal gastrectomy, procedure with less blood loss, less pain, and quicker recovery than those of c BIA.

关 键 词：三角吻合 毕Ⅰ吻合 消化道重建 腹腔镜远端胃癌根治术 META分析 

分 类 号：R735.2[医药卫生—肿瘤]