Zhang Hong, Wang Jian, Wang Wenchen, Zhou Lin, Chen Jiakuan, Yang Bo, Xia Yanmin, Jiang Tao
Department of Thoracic Surgery, Tang Du Hospital, The Fourth Military Medical University, Xi'an 710038, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2014 Sep;17(9):892-7.
Investigate the best surgical resection of esophageal cancer by comparing the efficacy and safety between Ivor-Lewis esophagectomy and Sweet esophagectomy.
The relevant literatures comparing Ivor-Lewis esophagectomy with Sweet esophagectomy were searched through PubMed, Embase, the Cochrane Library, Google scholar, CNKI, CBM, VIP, WanFang Data. RevMan 5.2 software was used for data analysis.
A total of 4106 patients in 15 studies were reviewed and the data were pooled for analysis. Meta-analysis showed that, compared with the Sweet group, Ivor-Lewis operative time was significantly longer(pooled mean difference=57.40; 95%CI:42.43 to 72.38; P=0.000), operative bleeding was significantly higher(pooled mean difference=28.39, 95%CI:4.06 to 52.72, P=0.02); the number of lymph node dissection significantly more(pooled mean difference=4.19, 95%CI:3.06 to 5.32, P=0.000); No significant difference was present in hospital stay, vocal cord paralysis, chylous leakage, pulmonary complications, anastomotic leakage(all P>0.05). The 5-year survival between the two groups showed no significant difference(P=0.52).
The two kinds of operation have the same long term effect. Compared with Ivor-Lewis operation, Sweet operation is easier to perform, less time consuming and more tolerable. Ivor-Lewis operation can dissect more lymph nodes than Sweet operation, without increased complications.
通过比较Ivor-Lewis食管癌切除术与Sweet食管癌切除术的疗效和安全性，探讨食管癌的最佳手术切除方式。
通过PubMed、Embase、Cochrane图书馆、谷歌学术、中国知网、中国生物医学文献数据库、维普资讯、万方数据检索比较Ivor-Lewis食管癌切除术与Sweet食管癌切除术的相关文献。采用RevMan 5.2软件进行数据分析。
共纳入15项研究中的4106例患者，并汇总数据进行分析。Meta分析显示，与Sweet组相比，Ivor-Lewis组手术时间显著延长（合并平均差=57.40；95%CI：42.43至72.38；P=0.000），术中出血量显著增加（合并平均差=28.39，95%CI：4.06至52.72，P=0.02）；淋巴结清扫数量显著更多（合并平均差=4.19，95%CI：3.06至5.32，P=0.000）；住院时间、声带麻痹、乳糜漏、肺部并发症、吻合口漏方面差异均无统计学意义（均P>0.05）。两组5年生存率差异无统计学意义（P=0.52）。
两种手术的远期效果相同。与Ivor-Lewis手术相比，Sweet手术操作更简便，耗时更少，耐受性更好。Ivor-Lewis手术比Sweet手术能清扫更多的淋巴结，且不增加并发症。
