中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

食管癌术后手工吻合和机械吻合安全性的比较:系统评价与 meta 分析

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目的 应用 meta 分析的方法比较食管癌术后手工吻合和机械吻合的安全性。 方法 通过计算机数据库检索 PubMed、Embase、The Cochrane Library 数据库,人工查找有关食管癌术后患者手工吻合和机械吻合的随机对照试验,检索时间为建库至 2017 年 12 月。由 2 位作者按纳入、排除标准独立的筛选文献、提取资料和评价偏倚风险,再采用 R 软件的 Meta 包进行 Meta 分析。 结果 最终纳入 17 个 RCTs,包括 2 159 例患者,其中手工吻合组 1 230 例,机械吻合组 1 289 例。meta 分析结果显示:手工吻合和机械吻合相比吻合口漏发生率差别无统计学意义[RR=0.996,95%CI(0.6740,1.471),P=0.983]、术后 30 d 内的死亡率差别无统计学意义[RR=0.950,95%CI(0.607,1.489),P=0.825];亚组分析结果发现线形吻合器组与手工吻合组相比,可以减低吻合口狭窄的风险[RR=0.744,95%CI(0.484,1.144),P=0.179],而圆形吻合器可能会增加吻合口狭窄的风险[RR=3.002,95%CI(1.815–4.964),P<0.001]。 结论 食管癌手术使用线形吻合器可以减低术后发生吻合口狭窄的发生;而吻合口漏和 30 d 内死亡发生率手工吻合、线形吻合器吻合和圆形吻合器吻合无差别。

Objctive To compare the safety of manual anastomosis and mechanical anastomosis after esophagectomy by meta-analysis. Methods A systematic literature search was based on an electrical database search, reference search, and hand search. Electronic databases included the Cochrane library, Embase, and Pubmed to identify relevant studies from inception to December 2017, without language restrictions. Two authors according to the inclusion and exclusion criteria independently research literature, extract data, evaluate bias risk and use R software meta package for meta-analysis. Results Seventeen RCTs were enrolled this meta-analysis, including 2 159 patients (1 230 HS anastomosis and 1 289 stapler anastomosis). The results of meta-analysis showed that: (1) There was no significant difference in the incidence of anastomotic leakage between staplers and HS (RR=0.996, 95%CI 0.6740–1.471, P=0.983); (2) Circular stapler might increase the incidence of anastomotic stenosis (RR=0.565, 95%CI 0.425–0.751, P<0.001) and linear stapler might reduce the incidence of anastomotic stenosis (RR=3.002, 95%CI 1.815–4.964, P<0.001), compared to HS; (3) No significant difference of 30-day mortality (RR=0.950, 95%CI 0.607–1.489, P=0.825). Subgroup analyses yielded no significant in the incidence of anastomotic leakage and anastomotic strictures for anastomosis configuration, site, layers, and publication year. Conclusion The use of linear staplers might reduce the incidence of anastomotic strictures compared with HS, but circular staplers might increase the incidence of anastomotic strictures. The liners stapler technique is more safe for esophageal cancer after esophagectomy.

关键词: 食管癌; 机械吻合; 手工吻合; 吻合口漏; 吻合口狭窄; 随机对照试验; meta 分析;  

Key words: Esophageal cancer; esophagectomy; hand-sewn sutures; mechanical sutures; anastomotic leakage; anastomotic stricture; RCT; meta-analysis

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