胃癌根治术中留置空肠造瘘管安全性和有效性评估的Meta分析  

Meta-analysis of the safety and efficacy assessment for the jejunostomy tube placement during the radical resection for gastric carcinoma

作　　者：金泽楠 张忠涛[1] Jin Zenan;Zhang Zhongtao(Department of General Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院普通外科,北京100050

出　　处：《国际外科学杂志》2022年第6期414-420,F0003,共8页International Journal of Surgery

基　　金：北京市科委重大项目资金资助(D171100006517003)。

摘　　要：目的探讨胃癌根治术中留置空肠造瘘管的安全性和有效性。方法以"胃癌根治术、食管癌切除术、空肠造瘘术、肠内营养"为中文检索词,以"gastrectomy、esophagectomy、jejunostomy、jejunostomies、enteral nutrition"为英文检索词,检索Pubmed、MEDLINE、EMbase、Web of Science、Cochrane Library数据库、中国知网数据库、维普数据库、万方数据库和CBMdisc数据库,收集2010年1月—2020年12月国内外公开发表的关于胃癌根治术后留置与不留置空肠造瘘管的中英文文献,包括随机对照试验和队列研究。主要观察指标为住院时间;次要观察指标为术后总体并发症发生率、术后肺部感染发生率、肠梗阻发生率和胃癌根治术后3、6个月体重变化。采用RevMan 5.2软件对数据进行统计学分析。结果最终纳入12篇文献,共2173例患者。与不留置组相比,留置组患者的住院时间(WMD=2.05,P=0.01)更长,肠梗阻发生率(OR=11.67,P<0.001)更高。术后总体并发症发生率(OR=1.24,P=0.31)、术后肺部感染发生率(OR=1.43,P=0.13)及胃癌根治术后3个月(WMD=0.58,P=0.24)、6个月(P>0.05)的体重变化等情况比较,差异均无统计学意义。结论胃癌根治术后常规留置空肠造瘘管并未显现出更多治疗方面的优势,反而延长了患者住院时间和肠梗阻发生率。因此,空肠造瘘管置入需要有选择性留置而不是常规应用。Objective To investigate the safety and efficacy of indignant jejunostomy tube in radical resection of gastric carcinoma.Methods Using"radical gastrectomy,esophagectomy,jejunostomy,enteral nutrition"as the Chinese search terms and"gastrectomy,esophagectomy,jejunostomy,jejunostomies,enteral nutrition"as the English search terms searched Pubmed,MEDLINE,EMbase,Web of Science,Cochrane Library,CNKI,VIP,Wanfang and CBMdisc.The Chinese and English literatures published at home and abroad on indwelling and non-indwelling jejunostomy tubes after radical resection of gastric carcinoma from January 2010 to December 2020 were collected,including randomized controlled trial and cohort studies.The main outcome measure was the length of hospital stay;the secondary outcome measure was the overall postoperative complication rate,postoperative pulmonary infection rate,intestinal obstruction rate,and body weight changes at 3 and 6 months after radical gastrectomy.Meta-analysis was conducted using RevMan 5.2 software.Results Finally,12 articles with a total of 2173 patients were included.Compared with the non-indwelling jejunostomy tube group,the patients in the indwelling group had a longer hospital stay(WMD=2.05,P=0.01)and a higher incidence of intestinal obstruction(OR=11.67,P<0.001).The incidence of overall postoperative complications(OR=1.24,P=0.31),the incidence of postoperative pulmonary infection(OR=1.43,P=0.13)and 3 months after radical gastrectomy(WMD=0.58,P=0.24),6 months(P>0.05),the difference were not statistically significant.Conclusions Indwelling jejunostomy tube placement after radical gastrectomy of gastric carcinoma did not show more therapeutic advantages,but prolonged the length of hospital stay and the probability of intestinal obstruction.Therefore,selective jejunostomy tube placement rather than routine jejunostomy placement should be required.

关 键 词：胃肿瘤 空肠造瘘管 安全性 有效性 META分析 

分 类 号：R735.2[医药卫生—肿瘤]