CAJ | 학술논문

背景：近10年来国内外学者提出了管状胃替代食管行消化道重建的方法，然而其术后并发症的发生率却一直存在争议。目的：评价食管癌根治术中管状胃代全胃行消化道重建的临床疗效。方法：计算机检索PubMed、OVID、CNKI、EBSCO、Science online、万方、超星数字图书馆、中国生物医学文献数据库(CMB)、以及百度和 Google 搜索引擎，关于食管癌根治术中以管状胃行消化道重建的临床RCT，由两名研究者严格按照纳入标准进行文献筛选，依据 Cochrane 协助网提供的标准评价文献质量及偏倚风险，采用GRADEprofiler 3.6.1软件评价文献的质量等级，采用Revman5.3软件对数据进行管理和统计分析。结果与结论：共纳入12篇文献共4137例患者，合并效应量结果表明管状胃组与全胃组相比较，吻合口瘘发生率、吻合口狭窄发生率两组差异无显著性意义，反流性食管炎发生率及胸胃综合征发生率管状胃组显著少于全胃组。结果表明，管状胃代全胃在食管癌根治术中行消化道重建是一种安全、有效的方法。但是由于纳入的文献仅为英文和中文文献，存在发表偏倚，个别文献样本量较小，尚需大样本高质量的临床RCT试验进一步验证。
배경：근10년래국내외학자제출료관상위체대식관행소화도중건적방법，연이기술후병발증적발생솔각일직존재쟁의。목적：평개식관암근치술중관상위대전위행소화도중건적림상료효。방법：계산궤검색PubMed、OVID、CNKI、EBSCO、Science online、만방、초성수자도서관、중국생물의학문헌수거고(CMB)、이급백도화 Google 수색인경，관우식관암근치술중이관상위행소화도중건적림상RCT，유량명연구자엄격안조납입표준진행문헌사선，의거 Cochrane 협조망제공적표준평개문헌질량급편의풍험，채용GRADEprofiler 3.6.1연건평개문헌적질량등급，채용Revman5.3연건대수거진행관리화통계분석。결과여결론：공납입12편문헌공4137례환자，합병효응량결과표명관상위조여전위조상비교，문합구루발생솔、문합구협착발생솔량조차이무현저성의의，반류성식관염발생솔급흉위종합정발생솔관상위조현저소우전위조。결과표명，관상위대전위재식관암근치술중행소화도중건시일충안전、유효적방법。단시유우납입적문헌부위영문화중문문헌，존재발표편의，개별문헌양본량교소，상수대양본고질량적림상RCT시험진일보험증。
BACKGROUND:Over the past 10 years, scholars have proposed the tubular stomach as an alternative to the whole stomach for digestive tract reconstruction; however, its occurrence rate of postoperative complications has been controversial. OBJECTIVE:To evaluate the clinical efficacy of tubular stomach versus whole stomach for digestive tract reconstruction in the resection of esophageal carcinoma. METHODS: The randomized controled trials about tubular stomach for digestive tract reconstruction in the resection of esophageal carcinoma were searched from PubMed, OVID, CNKI, EBSCO, Science online, Wangfang, Super Star Digital Library, CMB, Baidu and Google search engines. Two searchers screened studies based on the included criteria strictly. Literature quality and bias risk were assessed according to the criteria of Cochrane Colaboration, GRADEprofiler3.6.1 software was used for evaluation of the quality grade, and Revman5.3 for data management and statistical analysis. RESULTS AND CONCLUSION:Totaly 12 randomized controled trials including 4 137 patients were enroled. Compared with the whole stomach group, in the tubular stomach group, the incidences of reflux esophagitis and thoracic stomach syndrome were significantly lower, but there was no difference in the incidences of anastomotic leakage and anastomotic stenosis between the two groups. These findings indicate that the tubular stomach as a substitute of the whole stomach for digestive tract reconstruction in the resection of esophageal carcinoma is a safe and effective. However, the literatures included are only in English and Chinese, and there is publication bias and smal sample size. Therefore, the large-sample high-quality clinical randomized controled trials are stil needed for further confirmation.