Munnangi S, Sonnenberg A
Department of Veterans Affairs Medical Center, Albuquerque, New Mexico, USA.
Am J Gastroenterol. 1997 Jan;92(1):109-13.
Until now, the question of whether previous gastric surgery results in an increased risk of colorectal cancer has remained controversial. A meta-analysis was performed to resolve this issue.
The numbers of colorectal tumors in the two populations with and without gastric surgery were retrieved from all relevant articles found through a MEDLINE search. If available, the most detailed breakdown of the data by patient gender, type of peptic ulcer, type of surgery, time since gastric surgery, and by tumor location was chosen. The Mantel-Haenszel procedure was used to calculate a weighted odds ratio from the individual studies. The method of DerSimonian and Laird was used to calculate a weighted average of the difference between tumor rates in patients with and without gastric surgery.
The summary odds ratio was 1.09 with a 95% confidence interval of 0.96-1.24. The length of time after surgery, gender, tumor location, initial ulcer type, and different types of surgery were not associated with any significant influence. The summary rate difference was not significantly different from zero. The test for heterogeneity yielded a chi 2 = 26.87, df = 13, p = 0.013. After ignoring one obvious outlier study, the chi 2 test dropped to a nonsignificant level. A L'Abbé plot failed to show any prevailing influence of rate size on the overall heterogeneity among the various studies.
Surgery for peptic ulcer does not result in an increased risk for colorectal tumors. This lack of influence was shown consistently by all tests of the present meta-analysis.
迄今为止，既往胃手术是否会增加结直肠癌风险的问题一直存在争议。进行了一项荟萃分析以解决该问题。
通过医学文献数据库（MEDLINE）检索所有相关文章，获取有胃手术史和无胃手术史两组人群中的结直肠肿瘤数量。若数据可用，则选择按患者性别、消化性溃疡类型、手术类型、胃手术后时间以及肿瘤位置进行的最详细数据分类。采用曼特尔 - 亨塞尔程序从各个研究中计算加权比值比。使用德西蒙尼安和莱尔德方法计算有胃手术史和无胃手术史患者肿瘤发生率差异的加权平均值。
汇总比值比为1.09，95%置信区间为0.96 - 1.24。手术后时间长短、性别、肿瘤位置、初始溃疡类型以及不同手术类型均未显示出任何显著影响。汇总率差与零无显著差异。异质性检验得出卡方值 = 26.87，自由度 = 13，p = 0.013。在忽略一项明显的离群研究后，卡方检验降至无显著意义水平。L'Abbé图未显示率大小对各项研究总体异质性有任何主要影响。
消化性溃疡手术不会增加结直肠肿瘤风险。本荟萃分析的所有检验均一致表明不存在这种影响。
