食管切除后食管胃器械吻合与手工吻合疗效的 Meta 分析

目的：系统评价食管切除术后食管胃器械吻合与手工吻合的临床安全性和疗效。方法：计算机检索PubMed、EMbase、The Cochrane Library（2015年第11期）、Web of Science、CBM、CNKI、VIP 和 WanFang Data。检索时限均为各数据库建库至2015年11月30日，收集器械吻合与手工吻合对食管胃吻合术后吻合口并发症影响的相关的随机对照试验（RCT），按照纳入排除标准筛选文献，对符合标准的 RCT 由2位研究者独立进行资料提取和质量评价后，采用 Rev Man 5．3软件进行 Meta 分析。结果：纳入19个 RCT 共2558例。Meta分析显示：与手工吻合相比，器械吻合减少了手术时间MD ＝－20．75，95％CI（－31．42，－10．07），P ＝0．0001]，减少了吻合时间MD ＝－14．91，95％CI（－28．10，－1．72），P ＝0．03]，减少了术中出血量MD ＝－12．66，95％CI（－23．91，－1．41），P ＝0．03]；但在术后吻合口瘘发生率RR ＝0．77，95％CI（0．57，1．04），P＝0．09]，吻合口狭窄发生率RR ＝1．44，95％CI（0．95，2．19），P ＝0．09]，胃食管反流发生率RR ＝1．21，95％CI（0．86，1．69），P ＝0．28]，术后死亡率RR ＝1．15，95％CI（0．79，1．66），P ＝0．47]，肺部并发症发生率RR＝1．14，95％CI（0．92，1．43），P ＝0．24]和术后住院时间MD ＝－2．73，95％CI（－6．76，1．30），P ＝0．18]等方面，二者差异无统计学意义。结论：与手工吻合相比较，器械吻合可以减少手术时间、吻合时间及术中出血量，但对食管胃吻合术后吻合口瘘、吻合口狭窄、胃食管反流、术后死亡率、肺部并发症的发生率以及术后住院时间无显著影响。

Comparison of esophagogastric anastomosis by stapled versus hand -sewn-A Meta -analysis

Objective:To compare the clinical efficiency and safety of stapled versus hand -sewn esophagogastric anastomosis after esophageal ressection.Methods:We searched PubMed,EMbase,Cochrane Library(Issue 11 2015), Web of Knowledge,CNKI,CBM,WanFang Data and VIP up to November 2015.Randomized controlled trials involving the treatment outcome after stapled versus hand -sewn esophagogastric anastomosis were included.Data were extrac-ted and methodological quality was evaluated by two reviewers independently with a designed extraction form.Then Rev Man 5.3 software was used for Meta -analysis.Results:A total of 19 studies involving 2 558 patients were in-cluded.The results of Meta -analysis showed that comparing with hand -sewn esophagogastric anastomosis,stapled esophagogastric anastomosis could reduce the duration of operationMD =-20.75,95%CI(-31.42,-10.07),P=0.000 1],the duration of anastomosiMD =-14.91,95%CI(-28.10,-1.72),P =0.03]and blood lossMD=-12.66,95%CI(-23.91,-1.41 ),P =0.03].There was no statistical difference between the incidences of postoperative anasotmostic leaksRR =0.77,95%CI(0.57,1.04),P =0.09],anastomotic strictureRR =1.44, 95%CI(0.95,2.19),P =0.09],stroesophageal refluxRR =1.21,95%CI(0.86,1.69),P =0.28],mortalityRR=1.15,95%CI(0.79,1.66),P =0.47],pulmonary complicationRR =1.14,95%CI(0.92,1.43),P =0.24]or hospital stayMD =-2.73,95%CI(-6.76,1.30),P =0.18].Conclusion:Comparing with hand -sewn esopha-gogastric anastomosis,stapled esophagogastric anastomosis could reduce the duration of operation,the duration of anas-tomosis and blood loss,but there was no statistically difference between anastomostic leak,anastomotic stricture,stroe-sophageal reflux,mortality,pulmonary complication or hospital stay.