CAJ | 학술논문

目的：比较近端胃切除术和全胃切除术治疗食管胃结合部癌（SiewertⅡ~Ⅲ型）的疗效。方法检索Cochrane、Medline、Embase、中国期刊全文数据库及万方数据库中1990-2012年间比较近端胃切除术和全胃切除术治疗食管胃结合部癌的临床研究。使用RevMan 5．0软件对病死率、并发症发生率及术后营养状况进行Meta分析。结果共10篇文献2481例患者入选研究，其中近端胃切除组862例，全胃切除组1619例。分析显示，近端胃切除组与全胃切除组病死率（OR＝1．00， P＝0．99）、并发症发生率（OR＝2．14， P＝0．12）及术后营养状况（WMD＝2．09， P＝0．57）的差异均无统计学意义。全胃切除组较近端胃切除组术后吻合口狭窄（OR＝5．40， P＜0．01）及反流性食管炎（OR＝7．12， P＝0．01）的发生率明显降低。结论全胃切除术作为一项安全、有效的手术方式，在降低术后吻合口狭窄及反流性食管炎方面优于近端胃切除术。
목적：비교근단위절제술화전위절제술치료식관위결합부암（SiewertⅡ~Ⅲ형）적료효。방법검색Cochrane、Medline、Embase、중국기간전문수거고급만방수거고중1990-2012년간비교근단위절제술화전위절제술치료식관위결합부암적림상연구。사용RevMan 5．0연건대병사솔、병발증발생솔급술후영양상황진행Meta분석。결과공10편문헌2481례환자입선연구，기중근단위절제조862례，전위절제조1619례。분석현시，근단위절제조여전위절제조병사솔（OR＝1．00， P＝0．99）、병발증발생솔（OR＝2．14， P＝0．12）급술후영양상황（WMD＝2．09， P＝0．57）적차이균무통계학의의。전위절제조교근단위절제조술후문합구협착（OR＝5．40， P＜0．01）급반류성식관염（OR＝7．12， P＝0．01）적발생솔명현강저。결론전위절제술작위일항안전、유효적수술방식，재강저술후문합구협착급반류성식관염방면우우근단위절제술。
Objective To compare the efficacy of proximal gastrectomy (PG) and total gastrectomy (TG) for adenocarcinoma of esophagogastric junction. Methods Clinical trials comparing PG with TG for adenocarcinoma of esophagogastric junction published from 1990 to 2012 were searched in Cochrane library, Medline, Embase and China National Knowledge Infrastructure (CNKI), Wanfang Data. Review manager 5.0 was used for meta-analysis and outcome measures included mortality and complication morbidity, as well as nutritional state. Results A total of 10 studies including 2481 patients were identified and analyzed. The results showed no significant differences in the mortality (OR=1.00, P=0.99) and complication morbidity(OR=2.14, P=0.12) between PG and TG. However, anastomotic stenosis (OR=5.40, P<0.01) and reflux esophagitis (OR=7.12, P=0.01) were more frequently observed in PG group. The nutritional state in TG group was comparable with PG group (WMD=2.09, P=0.57). Conclusion TG is superior to PG in reducing the morbidity of anastomotic stenosis and reflux esophagitis.