中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2013年
2期
135-139
,共5页
胃肿瘤%全胃切除术%消化道重建%间置空肠代胃%Roux-en-Y吻合%Meta分析
胃腫瘤%全胃切除術%消化道重建%間置空腸代胃%Roux-en-Y吻閤%Meta分析
위종류%전위절제술%소화도중건%간치공장대위%Roux-en-Y문합%Meta분석
Stomach neoplasms%Total gastrectomy%Digestive tract reconstruction%Jejunal interposition%Roux-en-Y anastomosis%Meta-analysis
目的 比较胃癌全胃切除后间置空肠代胃术与Roux-en-Y吻合两种消化道重建方式术后远期并发症及患者的生活质量,为全胃切除后消化道重建方式的选择提供循证医学依据.方法 由两名研究者以“Gastrectomy”、“Roux-en-Y”和“Interposition”以及“全胃切除”、“间置空肠”为主题词和关键词检索PubMed、EMBASE、Cochrane、Library和Google Scholer等英文数据库和中文期刊全文数据库、中国生物医学文献数据库等,对纳入的研究文献进行数据提取并核对,采用RevMan5.0软件进行数据处理.结果 共纳入10篇文献计1628例胃癌全胃切除病例,其中消化道重建采用间置空肠代胃术728例,采用Roux-en-Y吻合术954例.与Roux-en-Y吻合术相比,间置空肠代胃术有助于降低患者的倾倒综合征发生率(OR=0.19,95％CI:0.11～0.34,P＜0.01)、提高预后营养指数(WMD=6.02,95％CI:1.82～10.22,P＜0.01)并改善术后体质量减轻程度(WMD=-2.45,95％CI:-3.81～-1.71,P＜0.01),而两者在手术时间、住院时间及反流性食管炎发生率方面的差异则无统计学意义(均P＞0.05).结论 与Roux-en-Y吻合术相比,全胃切除后采用间置空肠代胃术进行消化道重建的胃癌患者,术后远期并发症发生率低,生活质量改善明显.
目的 比較胃癌全胃切除後間置空腸代胃術與Roux-en-Y吻閤兩種消化道重建方式術後遠期併髮癥及患者的生活質量,為全胃切除後消化道重建方式的選擇提供循證醫學依據.方法 由兩名研究者以“Gastrectomy”、“Roux-en-Y”和“Interposition”以及“全胃切除”、“間置空腸”為主題詞和關鍵詞檢索PubMed、EMBASE、Cochrane、Library和Google Scholer等英文數據庫和中文期刊全文數據庫、中國生物醫學文獻數據庫等,對納入的研究文獻進行數據提取併覈對,採用RevMan5.0軟件進行數據處理.結果 共納入10篇文獻計1628例胃癌全胃切除病例,其中消化道重建採用間置空腸代胃術728例,採用Roux-en-Y吻閤術954例.與Roux-en-Y吻閤術相比,間置空腸代胃術有助于降低患者的傾倒綜閤徵髮生率(OR=0.19,95％CI:0.11～0.34,P＜0.01)、提高預後營養指數(WMD=6.02,95％CI:1.82～10.22,P＜0.01)併改善術後體質量減輕程度(WMD=-2.45,95％CI:-3.81～-1.71,P＜0.01),而兩者在手術時間、住院時間及反流性食管炎髮生率方麵的差異則無統計學意義(均P＞0.05).結論 與Roux-en-Y吻閤術相比,全胃切除後採用間置空腸代胃術進行消化道重建的胃癌患者,術後遠期併髮癥髮生率低,生活質量改善明顯.
목적 비교위암전위절제후간치공장대위술여Roux-en-Y문합량충소화도중건방식술후원기병발증급환자적생활질량,위전위절제후소화도중건방식적선택제공순증의학의거.방법 유량명연구자이“Gastrectomy”、“Roux-en-Y”화“Interposition”이급“전위절제”、“간치공장”위주제사화관건사검색PubMed、EMBASE、Cochrane、Library화Google Scholer등영문수거고화중문기간전문수거고、중국생물의학문헌수거고등,대납입적연구문헌진행수거제취병핵대,채용RevMan5.0연건진행수거처리.결과 공납입10편문헌계1628례위암전위절제병례,기중소화도중건채용간치공장대위술728례,채용Roux-en-Y문합술954례.여Roux-en-Y문합술상비,간치공장대위술유조우강저환자적경도종합정발생솔(OR=0.19,95％CI:0.11～0.34,P＜0.01)、제고예후영양지수(WMD=6.02,95％CI:1.82～10.22,P＜0.01)병개선술후체질량감경정도(WMD=-2.45,95％CI:-3.81～-1.71,P＜0.01),이량자재수술시간、주원시간급반류성식관염발생솔방면적차이칙무통계학의의(균P＞0.05).결론 여Roux-en-Y문합술상비,전위절제후채용간치공장대위술진행소화도중건적위암환자,술후원기병발증발생솔저,생활질량개선명현.
Objective To compare the incidence of postoperative long-term complications and quality of life between two digestive tract reconstruction techniques after total gastrectomy in order to provide evidence for clinical practice.Methods A systematic literature search was carried out to obtain studies of randomized controlled trials (RCTs) of reconstruction techniques including jejunal interposition and Roux-en-Y.Data extracted from RCTs for meta-analysis were independently assessed by two reviewers.A meta-analysis was performed by RevMan5.0 software.Results A total of 1628 gastric cancer cases undergoing total gastrectomy from 10 RCTs were eligible for inclusion,among whom 728 received jejunal interposition reconstruction and 954 Roux-en-Y anastomosis.As compared with Roux-en-Y anastomosis,jejunal interposition reconstruction significantly decreased the incidence of dumping syndrome (OR=0.19,95％CI:0.11-0.34,P＜0.01),increased the prognostic nutritional index (WMD=6.02,95％CI:1.82-10.22,P＜0.01),and improved the body weight postoperatively (WMD=-2.45,95％CI:-3.81--1.71,P＜0.01).Meanwhile,jejunal interposition reconstruction did not prolong operative time and hospital stay (both P＞0.05).Conclusion Jejunal interposition has better efficacy than Roux-en-Y in dumping syndrome and quality of life,and is a reasonable and effective digestive tract reconstruction for long-term survival of gastric cancer patients.
