背景:已经发表了比较近端胃切除术后几种重建方法的其他研究;值得注意的是,有必要从现有的循证文献中更新系统综述和荟萃分析.
目的:为了扩大目前关于可行性和安全性的知识,并分析近端胃切除术后几种重建技术的术后结果。
方法:PubMed,谷歌学者,搜索Medline数据库寻找原始研究,选择了1966年至2019年之间发表的有关近端胃切除术的各种重建技术的相关文献。评估重建技术的术后结果和并发症。使用Rev-Man5.0进行Meta分析。共有29项研究调查了双束重建术后的结果,空肠囊插入,空肠间置术,食管胃吻合术,最终选择双皮瓣重建进行定量分析。
结果:用于双道重建的反流性食管炎的合并发生率,空肠囊插入,空肠间置食管胃吻合术,双皮瓣重建占8.6%,13.8%,13.8%,19.3%,和8.9%。Meta分析显示,与JPI组相比,JI组的住院时间减少(异质性:Chi2=1.34,df=1(P=0.25);I2=26%,总效应检验:Z=2.22(P=0.03)。JI和EG在住院时间上也有显着差异,具有异质性:Chi2=1.40,df=3(P=0.71);I2=0%,总效应检验:Z=5.04(P<0.00001)。与JI组相比,EG组的手术时间更短(异质性:Chi2=31.09,df=5(P<0.00001);I2=84%,综合效果检验:Z=32.35(P<0.00001)。
结论:尽管目前的重建技术具有优异的抗反流功效,最优的重建方法还有待确定。经证实双皮瓣重建可降低并发症发生率,但是DTR,JI,JPI,EG组吻合口漏并发症发生率较高,吻合口狭窄,和残留的食物。在荟萃分析结果中,JI之间的并发症,JPI,和EG具有可比性,但EG组显示出更好的手术时间,失血,和住院时间。
BACKGROUND: Additional studies comparing several reconstruction methods after proximal gastrectomy have been published; of note, it is necessary to update systematic reviews and meta-analysis from the current evidence-based literature.
OBJECTIVE: To expand the current knowledge on feasibility and safety, and also to analyze postoperative outcomes of several reconstructive techniques after proximal gastrectomy.
METHODS: PubMed, Google Scholar, and Medline databases were searched for original studies, and relevant literature published between the years 1966 and 2019 concerning various reconstructive techniques on proximal gastrectomy were selected. The postoperative outcomes and complications of the reconstructive techniques were assessed. Meta-analyses were performed using Rev-Man 5.0. A total of 29 studies investigating postoperative outcomes of double tract reconstruction, jejunal pouch interposition, jejunal interposition,
esophagogastrostomy, and double flap reconstruction were finally selected in the quantitative analysis.
RESULTS: Pooled incidences of reflux esophagitis for double tract reconstruction, jejunal pouch interposition, jejunal interposition
esophagogastrostomy, and double flap reconstruction were 8.6%, 13.8%, 13.8%, 19.3%, and 8.9% respectively. Meta-analysis showed a decreased length of hospital in the JI group as compared to the JPI group (heterogeneity: Chi2 = 1.34, df = 1 (P = 0.25); I2 = 26%, test for overall effect: Z = 2.22 (P = 0.03). There was also a significant difference between JI and EG in length of hospital stay with heterogeneity: Chi2 = 1.40, df = 3 (P = 0.71); I2 = 0%, test for overall effect: Z = 5.04 (P < 0.00001). Operative time was less in the EG group as compared to the JI group (heterogeneity: Chi2 = 31.09, df = 5 (P < 0.00001); I2 = 84%, test for overall effect: Z = 32.35 (P < 0.00001).
CONCLUSIONS: Although current reconstructive techniques present excellent anti-reflux efficacy, the optimal reconstructive method remains to be determined. The double flap reconstruction proved to lower the rate of complication, but the DTR, JI, JPI, and EG groups showed higher incidence of complications in anastomotic leakage, anastomotic stricture, and residual food. In the meta-analysis result, the complications between the JI, JPI, and EG were comparable but the EG group showed to have better postoperative outcomes concerning the operative time, blood loss, and length of hospital stay.