胃癌患者行远端胃切除术后不同消化道重建方式的荟萃分析  

Comparison of different reconstruction procedures after distal gastrectomy in patients with gastric cancer

作　　者：张红雨[1] 孙楠[2] 赵春临[1] 梁卫杰 叶延伟[1] 刘光辉[1] 丁朝辉[1] 赵红超[1] Zhang Hongyu;Sun Nan;Zhao Chunlin;Liang Weijie;Ye Yanwei;Liu Guanghui;Ding Zhaohui;Zhao Hongchao(Department of Gastrointestinal Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Plastic Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院胃肠外科,郑州450052 [2]郑州大学第一附属医院整形外科,郑州450052

出　　处：《中华医学杂志》2020年第48期3884-3889,共6页National Medical Journal of China

摘　　要：目的运用荟萃分析方法系统评价胃癌患者在行远端胃切除术后,Roux-en-Y相对于BillrothⅠ或BillrothⅡ的消化道重建方式,何种方法患者获益较大。方法系统性检索Pubmed、Embase、万方数据库、中国知网和维普数据网从建库至2019年8月18日相关文献,严格筛选关于胃癌患者行远端胃切除术后,Roux-en-Y对比BillrothⅠ或BillrothⅡ的消化道重建方式的随机对照临床试验,应用Revman 5.3软件进行统计分析,研究的指标包括手术相关指标和术后相关结局。结果系统地检索出783篇相关文献,经严格筛选,最终符合纳入标准的有6篇临床随机对照研究,包含954例患者。荟萃分析结果显示,BillrothⅠ和Roux-en-Y比较,手术时间BillrothⅠ明显短于Roux-en-Y(加权均数差MD=-37.60,95%CI:-50.79^-24.40,P<0.001),术中出血BillrothⅠ明显少于Roux-en-Y(加权均数差MD=-21.64,95%CI:-32.20^-11.07,P<0.001),胃排空延迟发生例数BillrothⅠ显著少于Roux-en-Y(RR=0.52,95%CI:0.31~0.86,P=0.01),而胆汁反流(RR=8.17,95%CI:2.21~31.53,P=0.002)、残胃炎(RR=1.75,95%CI:1.43~2.14,P<0.00001)发生例数BillrothⅠ显著多于Roux-en-Y,其余结局指标比较差异无统计学意义。BillrothⅡ和Roux-en-Y比较,手术时间BillrothⅡ明显短于Roux-en-Y(加权均数差MD=-19.73,95%CI:-32.82^-6.64,P=0.003),而胆汁反流(RR=17.63,95%CI:4.50~69.02,P<0.001)、残胃炎(RR=1.94,95%CI:1.15~3.26,P=0.01)、反流性食管炎(RR=3.13,95%CI:1.31~7.45,P=0.01)发生例数BillrothⅡ显著多于Roux-en-Y,其余结局指标比较差异无统计学意义。结论行远端胃切除术的胃癌患者,Roux-en-Y的消化道重建方式相对于BillrothⅠ和BillrothⅡ,手术时间较长,但有较低的胆汁反流、残胃炎发生率,术后生活质量较好。Objective To systematically compare the effect of Roux-en-Y with BillrothⅠor BillrothⅡin gastric cancer patients after distal gastrectomy by meta-analysis.Methods Systematic search was conducted on the relevant electronic databases of Pubmed,Embase,Wanfang Database,CNKI and VIP from the established time to August 18,2019.The randomized controlled trials about comparison of Roux-en-Y with BillrothⅠor BillrothⅡwere strictly screened and analyzed by the software of Revman 5.3.Procedure and postoperative outcomes were analyzed,respectively.Results A total of 783 relevant literatures were systematically retrieved,and 6 randomized controlled trials,including 954 patients,finally met the inclusion criteria after strict screening.The results of meta-analysis showed that operative time of BillrothⅠwas significantly shorter than that of Roux-en-Y(MD=-37.60,95%CI:-50.79--24.40,P<0.001),intraoperative bleeding(MD=-21.64,95%CI:-32.20--11.07,P<0.001)and the number of delayed gastric emptying(RR=0.52,95%CI:0.31-0.86,P=0.01)of BillrothⅠwere both significantly less than those of Roux-en-Y,while bile reflux(RR=8.17,95%CI:2.21-31.53,P=0.002)and residual gastritis(RR=1.75,95%CI:1.43-2.14,P<0.00001)of BillrothⅠwere both significantly higher than those of Roux-en-Y,other outcomes showed no significant difference.Compared with Roux-en-Y,operative time of BillrothⅡwas significantly shorter(MD=-19.73,95%CI:-32.82--6.64,P=0.003),while bile reflux(RR=17.63,95%CI:4.50-69.02,P<0.001),residual gastritis(RR=1.94,95%CI:1.15-3.26,P=0.01)and reflux esophagitis(RR=3.13,95%CI:1.31-7.45,P=0.01)of BillrothⅡwere all significantly higher,and there was no significant difference in other outcomes.Conclusion Compared with BillrothⅠand BillrothⅡ,the operation time of Roux-en-Y in gastric cancer patients undergoing distal gastrectomy is longer,but the incidences of bile reflux and residual gastritis are both lower,and the postoperative quality of life seems better.

关 键 词：胃肿瘤 远端胃切除术 消化道重建方式 

分 类 号：R735.2[医药卫生—肿瘤]