食管裂孔疝抗反流术保留迷走神经对术后复发风险影响的Meta分析

目的分析比较食管裂孔疝抗反流手术中迷走神经切断与保留对减少术后复发风险的影响。 方法检索Pubmed、Web of Science、Embase、ScienceDirect、ovid、CNKI数据库，检索建库至2019年9月，有关食管裂孔疝术中切断迷走神与保留迷走神经的临床研究，进行文献筛选、资料提取及质量评估，使用Cochrane5.1.0系统评价手册进行Meta分析。根据Cochrane循证医学指南的建议，二分类数据（食管裂孔疝复发与否）表示为比值比（odds ratio，OR）和95%可信区间。合并效应量的统计推断采用Z检验，以P＜0.05为差异有统计学意义。纳入研究结果间的异质性统计推断采用Q检验计算I²，如果I²＜50%，并且P＞0.1，则说明合并不存在异质性，采用固定效应模型进行合并，反之则用随机效应模型进行合并。明显的临床异质性采用亚组分析或敏感性分析等方法进行处理。 结果共纳入11项回顾性对照研究，根据术后食管裂孔疝复发的诊断方式将各研究分为解剖复发组和临床复发组。解剖复发组中，迷走神经切断430例，迷走神经保留383例；迷走神经切断复发风险大于迷走神经保留组（P＜0.05），相对危险度为1.96，95%可信区间（CI）=1.45~2.64。临床复发组中，迷走神经切断337例，迷走神经保留420例；迷走神经切断复发风险大于迷走神经保留（P＜0.05）。合并组分析显示，迷走神经切断术后复发风险大于迷走神经保留，相对危险度为1.78，95%可信区间（CI）=1.42~2.24，差异具有统计学意义（P＜0.05）。 结论抗反流术中保留迷走神经对减少食管裂孔疝术后复发可能具有积极意义，还需进一步临床试验进行验证。

Meta-analysis of the effect of postoperative recurrence in anti-reflux surgery with protection of vagus

ObjectiveTo analyze the effect of postoperative recurrence in anti-reflux surgery with protection of vagus. MethodsPubmed, web of science, Embase, ScienceDirect, ovid, CNKI database were searched and submitted for search until September 2019. A controlled clinical study comparing with or without vagotomy in anti-reflux surgery of the hiatal hernia was performed. Authors performed literature screening, data extraction and quality assessment. Cochrane 5.1.0 systematic review manual was applied for meta-analysis. ResultsA total of 11 retrospective clinical study were included. All the study were divided into two subgroups according to the methods of diagnosis for the recurrence of hiatal hernia:anatomic recurrence group and clinical recurrence group. More specifically,430 patients with vagotomy and 383 patients without vagotomy were included in anatomic recurrence group,.While 324 cases with vagotomy and 362 cases without vagotomy were analyzed in the other subgroup. The overall analysis of the included studies showed that compared with the non-vagotomy group, vagotomy group had a higher risk of postoperative recurrence of hiatal hernial in both subgroups.(P＜0.0001, OR=1.96, 95%CI: 1.45~2.64 in anatomic recurrence group, P=0.01, RR=1.56, 95%CI: 1.10-2.22 in clinical recurrence group respectively).Combined subgroup analysis shows that the risk of recurrence in vagotomy group is higer than that of non-vagotomy group, with a reletive risk of 1.78, and a 95% confidence interval of 1.42~2.24 (P＜0.00001), and the difference was statistically significant. ConclusionProtecting vagus in the procedure of anti-reflux surgery has a beneficial effect on reducing the postoperative recurrence, which deserves to practice in clinic.