带蒂大网膜包埋术预防食管癌术后并发症的Meta分析

摘要/Abstract

摘要：目的评价带蒂大网膜包埋术后食管癌患者的住院时间及并发症的发生率。方法计算机检索PubMed、EMbase、The Cochrane Library、Web of Science、中国生物医学文献数据库、中国期刊全文数据库、万方医药期刊全文数据库和维普中文科技期刊全文数据库，收集应用大网膜包埋术后与患者术后吻合口瘘相关的随机对照试验(RCT)，按照纳入排除标准筛选文献，由2位研究者对符合标准的RCT独立进行资料提取和质量评价后，采用RevMan 5.2软件进行Meta分析。结果共检索出206篇相关文献，最终纳入6个RCT，2 167例患者。Meta分析结果显示在术后吻合口瘘和住院时间方面，大网膜包埋术后患者吻合口瘘发生率（OR=0.19，95%CI为0.09～0.39，Z=4.55，P＜0.000 01）和住院时间（MD=-1.91，95%CI为-2.26～-1.57，Z=10.87，P＜0.000 01）明显低于常规食管胃吻合患者，其差异具有统计学意义。在吻合口狭窄和死亡率方面，大网膜包埋术后患者吻合口狭窄发生率（OR=0.76，95%CI为0.29～2.01，Z=0.55，P=0.58）和死亡率（OR=0.72，95%CI为0.24～2.21,Z=0.57，P=0.57）差异无统计学意义。结论与常规食管胃吻合相比较，带蒂大网膜包埋术可以降低食管癌患者术后吻合口瘘的发生率和住院时间，并且没有增加术后吻合口狭窄的发生率和患者的死亡率。

Abstract:ObjectiveTo evaluate the length of hospital stay and the incidences of complications after omentoplasty with nonomentoplasty for the patients with esophageal cancer. MethodsThe databases including Pubmed, Embase, The Cochrane Library, Web of Science, CBM, CNKI, VIP and Wanfang data were searched for collecting randomized controlled trials on the omentoplasty. According to the inclusive and exclusive criteria, the datas were extracted. Two reviewers independently screened literatures and assessed the qualities of the included studies and extracted data. Metaanalysis was performed by using of RevMan 5.2 software. ResultsA total of 6 RCTs including 2 167 patients from 206 original articles were included in this analysis. In terms of the anastomotic leakage after esophagectomy and the hospital stays, the incidence of anastomotic leakage (OR=0.19, 95%CI: 0.09～0.39, Z=4.55, P＜0.000 01) and hospital stays (MD=-1.91, 95%CI:-2.26-1.57, Z=10.87, P＜0.000 01) with omentoplasty was significantly lower than those of the nonomentoplasty, with significant differences. However, in terms of anastomotic stricture (OR=0.76，95%CI: 0.292.01, Z=0.55, P=0.58) and mortality rate (OR=0.72, 95%CI: 0.242.21, Z=0.57, P=0.57), there wrer no significant differences. ConclusionComparing with nonomentoplasty, the use of omentoplasty has beneficial effects for the postoperative complication such as anastomotic leakage and hospital stays, and does not increase the incidence of anastomotic stricture and mortality rate.

蔺瑞江, 胡文滕, 马敏杰, 魏宁, 韩彪. 带蒂大网膜包埋术预防食管癌术后并发症的Meta分析[J]. 国际肿瘤学杂志, 2015, 42(8): 666-.

LIN Rui-Jiang, HU Wen-Teng, MA Min-Jie, WEI Ning, HAN Biao. The use of omentoplasty after esophagectomy for esophageal cancer preventing complications: a metaanalysis[J]. Journal of International Oncology, 2015, 42(8): 666-.

参考文献

［1］ Kim SH, Lee KS, Shim YM, et al. Esophageal resection: indications, techniques, and radiologic assessment［J］. Radiographics, 2001, 21(5): 11191137. ［2］ Walther B, Johansson J, Johnsson F, et al. Cervical or thoracic anastomosis after esophageal resection and gastric tube reconstruction: a prospective randomized trial comparing sutured neck anastomosis with stapled intrathoracic anastomosis［J］. Ann Surg, 2003, 238(6): 803812. ［3］ Castro PM, Ribeiro FP, Rocha Ade F, et al. Handsewn versus stapler esophagogastric anastomosis after esophageal ressection: sistematic review and metaanalysis［J］. Arq Bras Cir Dig, 2014, 27(3): 216221. ［4］ Schuchert MJ, Abbas G, Nason KS, et al. Impact of anastomotic leak on outcomes after transhiatal esophagectomy［J］. Surgery, 2010, 148(4): 831840. ［5］ Fernandez FG, Meyers BF. Quality of life after esophagectomy［J］. Semin Thorac Cardiovas Surg, 2004, 16(2): 152159. ［6］ Shu YS, Sun C, Shi WP, et al. Tubular stomach or whole stomach for esophagectomy through cervicothoracoabdominal approach: a comparative clinical study on anastomotic leakage［J］. Ir J Med Sci, 2013, 182(3): 477480. ［7］ Peracchia A, Bardini R, Ruol A, et al. Esophagovisceral anastomotic leak. A prospective statistical study of predisposing factors［J］. J Thorac Cardiovasc Surg, 1988, 95(4): 685691. ［8］ Urschel JD. Esophagogastrostomy anastomotic leaks complicating esophagectomy: a review［J］. Am J Surg, 1995, 169(6): 634640. ［9］ Bhat MA, Dar MA, Lone GN, et al. Use of pedicled omentum in esophagogastric anastomosis for prevention of anastomotic leak［J］. Ann Thorac Surg, 2006, 82(5):18571862. ［10］ Dai JG, Zhang ZY, Min JX, et al. Wrapping of the omental pedicle flap around esophagogastric anastomosis after esophagectomy for esophageal cancer［J］. Surgery, 2011, 149(3): 404410. ［11］ Zheng QF, Wang JJ, Ying MG, et al. Omentoplasty in preventing anastomotic leakage of oesophagogastrostomy following radical oesophagectomy with threefield lymphadenectomy［J］. Eur J Cardiothorac Surg, 2013, 42(2): 274278. ［12］侯向生, 万清廉, 郑慧禹, 等. 大网膜环包术预防食管胃吻合口瘘临床应用体会［J］. 肿瘤防治研究, 2012, 39(1): 118119. ［13］王熠, 游继军. 食管癌手术方式改进预防吻合口瘘130例临床分析［J］. 中国当代医药, 2013, 20(6): 6465. ［14］陈光成, 吴桂奇, 陈云琦. 带蒂大网膜在食管贲门癌手术中的应用［J］. 南通医学院学报, 1997, 17(3): 392. ［15］ Swanson SJ, Batirel HF, Bueno R, et al. Transthoracic esophagectomy with radical mediastinal and abdominal lymphnode dissection and cervical esophagogastrostomy for esophageal carcinoma［J］. Ann Thorac surg, 2001, 72(6): 19181924. ［16］ Tabira Y, Yasunaga M, Sakaguchi T, et al. Outcome of histologically nodenegative esophageal squamous cell carcinoma［J］. World J Surg, 2002, 26(12): 14461451. ［17］ Tachibana M, Kinugasa S, Yoshimura H, et al. Clinical outcomes of extended esophagectomy with threefield lymph node dissection for esophageal squamous cell carcinoma［J］. Am J Surg, 2005, 189(1): 98109. ［18］ Messmann H, Schmidbaur W, Jckle J, et al. Endoscopic and surgical management of leakage and mediastinitis after oesophageal surgery［J］. Best Pract Res Clin Gastroenterol, 2004, 18(5): 809927. ［19］ Turkyilmaz A, Eroglu A, Aydin Y, et al. The management of esophagogastric anastomotic leak after oesophagectomy for oesophageal carcinoma［J］. Dis Oesophagus, 2009, 22(2): 119126. ［20］陈正海. 带蒂大网膜在食管癌贲门癌手术中的应用体会［J］. 吉林医学, 2010, 31(25): 43674368. ［21］ Zhang QX, Magovern CJ, Mack CA, et al. Vascular endothelial growth factor is the major angiogenic factor in omentum: mechanism of the omentummediated angiogenesis［J］. J Surg Res, 1997, 67(2): 147154. ［22］李保田, 阎水长, 张清春, 等. 食管癌贲门癌术后吻合口瘘的预防:附584例报告［J］. 中华胸心血管外科杂志, 1996, 12(6): 339341. ［23］ Lerut TE, van Lanschot JJ. Chronic symptoms after subtotal or partial oesophagectomy: diagnosis and treatment［J］. Best Pract Res Clin Gastroenterol, 2004, 18(5): 901915. ［24］戴纪刚, 闵家新, 王静思, 等. 带蒂大网膜瓣袖套式包埋吻合口预防食管癌术后吻合口瘘［J］. 重庆医学, 2012, 41(26): 27592762. ［25］ Chalmers PJ, Newing RK. Influence of omentum transposition on experimental tumours［J］. J Surg Oncol, 1986, 32(3): 135137.