腹腔镜全胃切除术后食管空肠吻合口并发症的系统评价
Systematic review of anastomotic complications of esophagojejunostomy after laparoscopic total gastrectomy.
作者信息
Inokuchi Mikito, Otsuki Sho, Fujimori Yoshitaka, Sato Yuya, Nakagawa Masatoshi, Kojima Kazuyuki
机构信息
Mikito Inokuchi, Sho Otuski, Yoshitaka Fujimori, Yuya Sato, Masatoshi Nakagawa, Department of Surgical Oncology, Tokyo Medical and Dental University, Tokyo 113-8519, Japan.
出版信息
World J Gastroenterol. 2015 Aug 28;21(32):9656-65. doi: 10.3748/wjg.v21.i32.9656.
AIM
To investigate the anastomotic complications of esophagojejunostomy (EJS) after laparoscopic total gastrectomy (LTG), we reviewed retrospective studies.
METHODS
A literature search was conducted in PubMed for studies published from January 1, 1994 through January 31, 2015. The search terms included "laparoscopic," "total gastrectomy," and "gastric cancer." First, we selected 16 non-randomized controlled trials (RCTs) comparing LTG with open total gastrectomy (OTG) and conducted an updated meta-analysis of anastomotic complications after total gastrectomy. The Newcastle-Ottawa scoring system (NOS) was used to assess the quality of the non-RCTs included in this study. Next, we reviewed anastomotic complications in 46 case studies of LTG to compare the various procedures for EJS.
RESULTS
The overall incidence of anastomotic leakage associated with EJS was 3.0% (30 of 984 patients) among LTG procedures and 2.1% (31 of 1500 patients) among OTG procedures in the 16 non-RCTs. The incidence of anastomotic leakage did not differ significantly between LTG and OTG (odds OR = 1.42, 95%CI: 0.86-2.33, P = 0.17, I(2) = 0%). Anastomotic stenosis related to EJS was reported in 72 (2.9%) of 2484 patients, and the incidence was 3.2% among LTG procedures and 2.7% among OTG procedures. The incidence of anastomotic stenosis related to EJS was slightly, but not significantly, higher in LTG than in OTG (OR = 1.55, 95%CI: 0.94-2.54, P = 0.08, I(2) = 0%). The various procedures for LTG were classified into six categories in the review of case studies of LTG. The incidence of EJS leakage was similar (1.1% to 3.2%), although the incidence of EJS stenosis was relatively high when the OrVil™ device was used (8.8%) compared with other procedures (1.0% to 3.6%).
CONCLUSION
The incidence of anastomotic complications associated with EJS was not different between LTG and OTG. Anastomotic stenosis was relatively common when the OrVil™ device was used.
目的
为了研究腹腔镜全胃切除术（LTG）后食管空肠吻合术（EJS）的吻合口并发症，我们回顾了回顾性研究。
方法
在PubMed中检索1994年1月1日至2015年1月31日发表的研究。检索词包括“腹腔镜”“全胃切除术”和“胃癌”。首先，我们选择了16项比较LTG与开放全胃切除术（OTG）的非随机对照试验（RCT），并对全胃切除术后的吻合口并发症进行了更新的荟萃分析。使用纽卡斯尔-渥太华评分系统（NOS）评估本研究中纳入的非RCT的质量。接下来，我们回顾了46例LTG病例研究中的吻合口并发症，以比较EJS的各种手术方法。
结果
在16项非RCT中，LTG手术中与EJS相关的吻合口漏的总体发生率为3.0%（984例患者中的30例），OTG手术中为2.1%（1500例患者中的31例）。LTG和OTG之间吻合口漏的发生率无显著差异（优势比OR = 1.42，95%置信区间：0.86 - 2.33，P = 0.17，I² = 0%）。2484例患者中有72例（2.9%）报告了与EJS相关的吻合口狭窄，LTG手术中的发生率为3.2%，OTG手术中的发生率为2.7%。与EJS相关的吻合口狭窄的发生率在LTG中略高于OTG，但无显著差异（OR = 1.55，95%置信区间：0.94 - 2.54，P = 0.08，I² = 0%）。在LTG病例研究的回顾中，LTG的各种手术方法分为六类。EJS漏的发生率相似（1.1%至3.2%），尽管与其他手术方法（1.0%至3.6%）相比，使用OrVil™装置时EJS狭窄的发生率相对较高（8.8%）。
结论
LTG和OTG之间与EJS相关的吻合口并发症的发生率没有差异。使用OrVil™装置时，吻合口狭窄相对常见。
Zotero 插件