近端胃切除联合双通道吻合技术治疗胃上部癌安全性及有效性的Meta分析  

Safety and efficacy of proximal gastrectomy with double tract anastomosis reconstruction for upper gastric cancer: a meta-ananlysis

作　　者：杜耀 张江南[1] 李卫平[2] 王益[2] Du Yao;Zhang Jiangnan;Li Weiping;Wang Yi(Department of Gastrointestinal Surgery,The First Affiliated Hospital,Nanchang University,Nanchang 330006,China;Department of Gastrointestinal Surgery,Taicang Hospital,Soochow University(The First People's Hospital of Taicang),Taicang 215400,China)

机构地区：[1]南昌大学第一附属医院胃肠外科,南昌330006 [2]苏州大学附属太仓医院(太仓市第一人民医院)胃肠外科,太仓215400

出　　处：《中华胃肠外科杂志》2022年第1期71-81,共11页Chinese Journal of Gastrointestinal Surgery

基　　金：苏州市"科教兴卫"青年科技项目(KJXW2020071)。

摘　　要：目的探讨近端胃切除联合双通道吻合技术治疗胃上部癌的安全性及有效性。方法检索PubMed、Embase、Cochrane Library、Wiley Online Library、Web of Science、中国知网、万方数据库及维普数据库公开发表的有关胃上部癌行近端胃切除联合双通道吻合技术(PG-DT)和全胃切除Roux-en-Y消化道重建术(TG-RY)的中英文文献。文献纳入标准:(1)公开发表的关于胃上部癌行PG-DT及TG-RY的前瞻性或回顾性对照研究;(2)研究对象为胃上部癌;(3)纳入文献必须至少包含以下一项指标:手术时间、术中出血量、术后排气时间、术后进食时间、住院时间、清扫淋巴结数量、术后并发症、术后1年白蛋白、术后1年血红蛋白、术后1、3及5年生存率。排除综述、病例报告、会议摘要和其他非对照研究的文献资料和重复发表的研究以及数据提取不完整或无法提取的研究。检索时间截止至2021年2月。采用卡斯尔-渥太华(NOS)、Jadad改良文献质量评价量表分别对回顾性研究和前瞻性对照研究进行文献质量评估。采用Review Manager 5.3软件制作森林图进行Meta分析, 采用漏斗图评估发表偏倚, 采用Egger检测是否存在发表偏倚。结果共检索385篇文献, 最终纳入18篇文献, 其中2篇为随机对照研究, 16篇为回顾性队列研究, 共计纳入1 521例患者, 其中PG-DT组692例, TG-RY组829例。对纳入指标进行Meta分析, 疗效指标比较显示:与TG-RY组比较, PG-DT组患者术中出血量少(OR=-54.58, 95%CI:-57.77~-51.38)、术后排气时间早(OR=-0.21, 95%CI:-0.29~-0.13)、住院时间短(OR=-0.98, 95%CI:-1.31~-0.64)、清扫淋巴结数少(OR=-6.07, 95%CI:-7.14~-4.99)、术后并发症发生率低(OR= 0.32, 95%CI:0.24~0.43)、术后1年白蛋白和血红蛋白水平高(分别:OR=1.90, 95%CI:1.08~2.77;OR=5.07, 95%CI:2.83~7.31), 差异均有统计学意义(均P<0.001);而手术时间(OR=0.08, 95%CI:-4.24~4.39, P=0.97)、术后进食时间(OR=-0.05, 95%CI:-0.15~0.Objective It is not yet to be clarified whether proximal gastrectomy with double tract anastomosis reconstruction(PG-DT)for gastric cancer increases postoperative complications.This meta-analysis aims to evaluate the safety and efficacy of PG-DT for upper gastric cancer.Methods The Chinese and English literatures about PG-DT and total gastrectomy with Roun-en-Y digestive tract reconstruction(TG-RY)for upper gastric cancer were searched from PubMed,Embase,Cochrane Library,Wiley Online Library,Web of Science,CNKI net,Wanfang database and VIP database.Literature inclusion criteria:(1)prospective or retrospective cohort study of PG-DT and TG-RY for upper gastric cancer published publicly;(2)patients with upper gastric cancer;(3)the enrolled literatures included at least one of the following outcome indicators:operation time,intraoperative blood loss,postoperative exhaust time,postoperative feeding time,hospitalization time,number of harvested lymph nodes,postoperative complications,postoperative 1-year albumin,postoperative 1-year hemoglobin and 1-,3-,5-year survival after surgery.Literature exclusion criteria:(1)reviews,case reports,conference summaries and other non-control studies;(2)studies published repeatedly,studies with incomplete or unextractable information.The search time ended in February 2021.The basic information and evaluation indicators included in the article were extracted.The retrospective study was evaluated using Newcastle-Ottawa literature quality evaluation scale.The prospective randomized controlled study was evaluated using Jadad modified scale.Meta-analysis was performed using Review Manager 5.3.Publication bias was assessed using funnel map.Publication bias was tested using Egger tools.Results A total of 385 literatures were searched,finally 2 randomized controlled trials and 16 retrospective cohort study were included.There were 1521 patients,including 692 in the PG-DT group and 829 in the TG-RY group.The meta-analysis of the enrolled indicators showed that as compared to TG-RYT group,PG-D

关 键 词：胃肿瘤 近端 双通道 胃上部癌 META分析 

分 类 号：R735.2[医药卫生—肿瘤]