Zhang H Y, Sun N, Zhao C L, Liang W J, Ye Y W, Liu G H, Ding Z H, Zhao H C
Department of Gastrointestinal Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Department of Plastic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Zhonghua Yi Xue Za Zhi. 2020 Dec 29;100(48):3884-3889. doi: 10.3760/cma.j.cn112137-20200422-01279.
To systematically compare the effect of Roux-en-Y with Billroth Ⅰ or Billroth Ⅱ in gastric cancer patients after distal gastrectomy by meta-analysis. Systematic search was conducted on the relevant electronic databases of Pubmed, Embase, Wanfang Database, CNKI and VIP from the established time to August 18, 2019. The randomized controlled trials about comparison of Roux-en-Y with Billroth Ⅰ or Billroth Ⅱ were strictly screened and analyzed by the software of Revman 5.3. Procedure and postoperative outcomes were analyzed, respectively. A total of 783 relevant literatures were systematically retrieved, and 6 randomized controlled trials, including 954 patients, finally met the inclusion criteria after strict screening. The results of meta-analysis showed that operative time of Billroth Ⅰ was significantly shorter than that of Roux-en-Y (=-37.60, 95:-50.79--24.40, 0.001), intraoperative bleeding (=-21.64, 95:-32.20--11.07, 0.001) and the number of delayed gastric emptying (0.52, 95: 0.31-0.86, 0.01) of Billroth Ⅰ were both significantly less than those of Roux-en-Y, while bile reflux (8.17, 95: 2.21-31.53, 0.002) and residual gastritis (1.75, 95:1.43-2.14, 0.000 01) of Billroth Ⅰ were both significantly higher than those of Roux-en-Y, other outcomes showed no significant difference. Compared with Roux-en-Y, operative time of Billroth Ⅱ was significantly shorter (=-19.73, 95:-32.82--6.64, 0.003), while bile reflux (17.63, 95: 4.50-69.02, 0.001), residual gastritis (1.94, 95:1.15-3.26, 0.01) and reflux esophagitis (3.13, 95: 1.31-7.45, 0.01) of Billroth Ⅱ were all significantly higher, and there was no significant difference in other outcomes. Compared with Billroth Ⅰ and Billroth Ⅱ, the operation time of Roux-en-Y in gastric cancer patients undergoing distal gastrectomy is longer, but the incidences of bile reflux and residual gastritis are both lower, and the postoperative quality of life seems better.
通过Meta分析系统比较胃癌患者远端胃切除术后Roux-en-Y吻合术与毕Ⅰ式或毕Ⅱ式吻合术的效果。对PubMed、Embase、万方数据库、中国知网和维普从建库至2019年8月18日的相关电子数据库进行系统检索。采用Revman 5.3软件对Roux-en-Y吻合术与毕Ⅰ式或毕Ⅱ式吻合术比较的随机对照试验进行严格筛选和分析。分别分析手术过程和术后结局。共系统检索到783篇相关文献，经严格筛选，最终6项随机对照试验符合纳入标准，包括954例患者。Meta分析结果显示，毕Ⅰ式吻合术的手术时间显著短于Roux-en-Y吻合术（=-37.60，95%CI：-50.79--24.40，P=0.001），毕Ⅰ式吻合术的术中出血量（=-21.64，95%CI：-32.20--11.07，P=0.001）和胃排空延迟次数（OR=0.52，95%CI：0.31-0.86，P=0.01）均显著少于Roux-en-Y吻合术，而毕Ⅰ式吻合术的胆汁反流（OR=8.17，95%CI：2.21-31.53，P=0.002）和残胃炎（OR=1.75，95%CI：1.43-2.14，P=0.000 01）均显著高于Roux-en-Y吻合术，其他结局差异无统计学意义。与Roux-en-Y吻合术相比，毕Ⅱ式吻合术的手术时间显著缩短（=-19.73，95%CI：-32.82--6.64，P=0.003），而毕Ⅱ式吻合术的胆汁反流（OR=17.63，95%CI：4.50-69.02，P=0.001）、残胃炎（OR=1.94，95%CI：1.15-3.26，P=0.01）和反流性食管炎（OR=3.13，95%CI：1.31-7.45，P=0.01）均显著更高，其他结局差异无统计学意义。与毕Ⅰ式和毕Ⅱ式吻合术相比，胃癌患者远端胃切除术后Roux-en-Y吻合术的手术时间较长，但胆汁反流和残胃炎的发生率均较低，术后生活质量似乎更好。
