目的:为了改善胃导管引流,食管切除术中常进行手术幽门成形术或幽门切开术。然而,临床重要性尚不清楚,一些中心选择省略这一步。这项荟萃分析的目的是比较肺部并发症的发生率,吻合口漏,死亡率,胃排空延迟,需要进一步的幽门干预,在有或没有引流手术的食管切除术患者中。
方法:Medline的数据库搜索,EMBASE,和Cochrane图书馆进行研究,以确定2000年至2020年间发表的随机对照试验和队列研究,这些研究比较了有和无引流手术的食管切除术的结局.随机效应荟萃分析模型用于比较肺部并发症的发生率,吻合口漏,死亡率,胃排空延迟,以及需要进一步的幽门干预。
结果:确定了3份随机和12份非随机出版物,共2339名患者。两组在肺部并发症方面无显著差异(RR1.02[95%CI,0.78-1.33],p=0.91),吻合口漏(RR1.14[95%CI,0.80-1.62],p=0.48),死亡率(RR0.53[95%CI,0.23-1.26],p=0.15),胃排空延迟(RR0.98[95%CI,0.59-1.62],p=0.93),以及需要进一步的幽门干预(RR1.99[95%CI,0.56-7.08],p=0.29)。
结论:在按需提供术后幽门治疗的情况下,手术幽门引流术对食管癌切除术患者的预后可能没有任何显著的临床影响,尽管需要进一步高质量的随机对照试验来证实这一点.
OBJECTIVE: Surgical pyloroplasty or
pyloromyotomy are often performed during esophagectomy with a view of improving gastric conduit drainage. However, the clinical importance of this is not clear, and some centers opt to omit this step. The aim of this meta-analysis is to compare the rates of pulmonary complications, anastomotic leak, mortality, delayed gastric emptying, and the need for further pyloric intervention, in patients undergoing esophagectomy with and without a drainage procedure.
METHODS: A database search of Medline, EMBASE, and Cochrane Library was performed to identify randomized control trials and cohort studies published between 2000 and 2020 which compared outcomes of esophagectomy with and without drainage procedures. A random-effects meta-analysis model was used to compare the rates of pulmonary complications, anastomotic leak, mortality, delayed gastric emptying, and the need for further pyloric intervention.
RESULTS: Three randomized and 12 non-randomized publications were identified, comprising a total of 2339 patients. No significant differences were found between the two groups with regard to pulmonary complications (RR 1.02 [95% CI, 0.78-1.33], p = 0.91), anastomotic leak (RR 1.14 [95% CI, 0.80-1.62], p = 0.48), mortality (RR 0.53 [95% CI, 0.23-1.26], p = 0.15), delayed gastric emptying (RR 0.98 [95% CI, 0.59-1.62], p = 0.93), and the need for further pyloric intervention (RR 1.99 [95% CI, 0.56-7.08], p = 0.29).
CONCLUSIONS: Where post-operative pyloric treatment is available on demand, surgical pyloric drainage procedures may not have any significant clinical impact on patient outcomes for patients undergoing esophagectomy, though further good-quality randomized controlled trials are needed to confirm this.