食管切除术后不同吻合方式抗反流效果的Meta分析  

Meta-analysis of Efficacies of Different Anti-Reflux Anastomosis Techniques after Esophageal Resection

作　　者：胡盛兵 马敏杰[2] 张瑜[2] 魏宁[2] 杨侃[2] 韩彪[2] 马立丽[2] 

机构地区：[1]兰州大学第一临床医学院研究生院,2012级兰州730000 [2]兰州大学第一医院胸外科,兰州730000

出　　处：《实用临床医学（江西）》2015年第11期26-30,共5页Practical Clinical Medicine

摘　　要：目的评价食管贲门癌切除术后常规吻合与附加胃底折叠术吻合在术后的抗反流效果。方法应用计算机检索PubMed、EMbase、Web of Knowledge、The Cochrane Library、中国生物医学文献数据库、万方数据、中国知网和维普数据库,查找常规吻合与附加胃底折叠术两种吻合方式对食管贲门癌切除术后抗反流效果的研究,检索时限均从建库至2015年1月。由2位评价员按纳入与排除标准独立筛选文献、提取资料并评价质量,采用RevMan 5.3软件进行Meta分析。结果共纳入11个研究、1 391例患者。Meta分析结果显示:与常规吻合相比,附加胃底折叠术术后能明显降低吻合口反流发生率[OR=0.18,95%CI(0.09,0.33),P<0.000 01]且不会增加术后吻合口狭窄率[OR=0.53,95%CI(0.28,0.99),P=0.05]。结论食管贲门癌切除术后附加胃底折叠术能明显减少吻合口反流情况的发生。Objective To evaluate the anti-reflux efficacies of conventional anastomosis and ad- ditional fundoplication anastomosis after esophagus or cardia cancer resection. Methods Electron- ic databases PubMed, EMbase, Web of Knowledge, the Cochrane Library, CBM, Wanfang Data, CNKI and CPVIP were searched for articles published from inception to January 2015 about the anti-reflux efficacies of conventional anastomosis and additional fundoplication anastomosis after esophagus or cardia cancer resection. According to the inclusion and exclusion criteria, two re- viewers independently screened literature, extracted data, and assessed methodological quality. The meta-analysis was performed using RevMan 5.3 software. Results A total of 11 RCTs invol- ving 1 391 patients were included. Compared with conventional anastomosis, additional fundopli- cation anastomosis could significantly reduce the incidence of anastomotic reflux[OR ~ 0. 18,95 % CI（0. 09,0. 33）, P〈0. 000 01], and could not increase the incidence of anastomotic stricture [OR：0.53,95%CI（0.28,0.99） ,P=0.05]. Conclusion The additional fundoplication can obvi- ously reduce the occurrence of anastomotic reflux after esophagus or cardia cancer resection.

关 键 词：胃底折叠 食管癌 反流 META分析 

分 类 号：R735.1[医药卫生—肿瘤]