Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan.
Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan.
Dis Esophagus. 2023 Sep 1;36(9). doi: 10.1093/dote/doac105.
Esophageal cancer patients require enteral nutritional support after esophagectomy. Conventional feeding enterostomy to the jejunum (FJ) is occasionally associated with small bowel obstruction because the jejunum is fixed to the abdominal wall. Feeding through an enteral feeding tube inserted through the reconstructed gastric tube (FG) or the duodenum (FD) using the round ligament of the liver have been suggested as alternatives. This meta-analysis aimed to compare short-term outcomes between FG/FD and FJ. Studies published prior to May 2022 that compared FG or FD with FJ in cancer patients who underwent esophagectomy were identified via electronic literature search. Meta-analysis was performed using the Mantel-Haenszel random-effects model to calculate Odds Ratios (ORs) with 95% confidence intervals (CIs). Five studies met inclusion criteria to yield a total of 1687 patients. Compared with the FJ group, the odds of small bowel obstruction (OR 0.09; 95% CI, 0.02-0.33), catheter site infection (OR 0.18; 95% CI, 0.06-0.51) and anastomotic leakage (OR 0.53; 95% CI, 0.32-0.89) were lower for the FG/FD group. Odds of pneumonia, recurrent laryngeal nerve palsy, chylothorax and hospital mortality did not significantly differ between the groups. The length of hospital stay was shorter for the FG/FD group (median difference, -10.83; 95% CI, -18.55 to -3.11). FG and FD using the round ligament of the liver were associated with lower odds of small bowel obstruction, catheter site infection and anastomotic leakage than FJ in esophageal cancer patients who underwent esophagectomy.
食管癌患者在接受食管切除术后需要进行肠内营养支持。传统的空肠喂养肠造口术（FJ）偶尔会发生小肠梗阻，因为空肠固定在腹壁上。使用肝圆韧带通过重建的胃管（FG）或十二指肠（FD）插入的喂养管已被提议作为替代方法。这项荟萃分析旨在比较 FG/FD 与 FJ 之间的短期结果。通过电子文献搜索，确定了在接受食管切除术的癌症患者中比较 FG 或 FD 与 FJ 的发表于 2022 年 5 月之前的研究。使用 Mantel-Haenszel 随机效应模型进行荟萃分析，以计算优势比（OR）及其 95%置信区间（CI）。五项研究符合纳入标准，共纳入 1687 名患者。与 FJ 组相比，FG/FD 组的小肠梗阻（OR 0.09；95%CI，0.02-0.33）、导管部位感染（OR 0.18；95%CI，0.06-0.51）和吻合口漏（OR 0.53；95%CI，0.32-0.89）的发生率较低。肺炎、喉返神经麻痹、乳糜胸和住院死亡率在两组之间无显著差异。FG/FD 组的住院时间更短（中位数差异，-10.83；95%CI，-18.55 至-3.11）。在接受食管切除术的食管癌患者中，与 FJ 相比，FG 和 FD 经肝圆韧带使用与小肠梗阻、导管部位感染和吻合口漏的发生率较低相关。
