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目的采用meta分析的方法,评价胃远端大部切除术后消化道重建中Billroth-Ⅰ吻合及Roux-en-Y吻合方式的围手术期安全性及中远期并发症。方法通过Embase、Pub Med、Med Line及The Cochrane Library数据库检索关于胃远端大部切除术后消化道重建中采用Billroth-Ⅰ吻合及Roux-en-Y吻合方式的随机对照试验(RCT)文献。检索开始于2015年12月1日,截止至2016年3月1日。根据制定的纳入和排除标准对检索到的文献进行筛选,采用改良Jadad量表对纳入研究的文献进行质量评价,采用Review Manager Version 5.1软件对数据进行meta分析。结果共纳入5篇RCT文献共600例患者,其中采用Roux-en-Y吻合的患者302例,采用Billroth-Ⅰ吻合的患者298例。meta分析结果提示:Billroth-Ⅰ吻合在手术时间〔WMD:38.95;95%CI:(19.86,58.04);P<0.000 1〕和术中出血量〔WMD:34.85;95%CI:(2.13,67.56);P=0.04〕方面较Roux-en-Y吻合有一定的优势,但是行Roux-en-Y吻合的患者在预防胆汁返流〔OR:0.03;95%CI:(0.01,0.11);P<0.000 01〕和残胃炎〔OR:0.37;95%CI:(0.25,0.54);P<0.000 01〕方面效果更好。在住院时间〔WMD:2.96;95%CI:(–0.00,5.93);P=0.05〕、吻合口漏〔OR:0.43;95%CI:(0.11,1.68);P=0.23〕、吻合口狭窄〔OR:1.84;95%CI:(0.61,5.53);P=0.27〕、返流性食管炎〔OR:0.63;95%CI:(0.28,1.44);P=0.27)及胃排空障碍〔OR:1.24;95%CI:(0.46,3.30);P=0.67〕方面Billroth-Ⅰ吻合及Roux-en-Y吻合比较差异均无统计学意义。结论 Billroth-Ⅰ吻合及Roux-en-Y吻合术式各有优缺点,Billroth-Ⅰ吻合在安全性方面更优,而Roux-en-Y吻合对于提高患者生活质量方面更优,但仍需要更多高质量的、设计精良、数据充足的RCT文献进行进一步验证。
Objective To evaluate the perioperative safety and long-term and long-term complications of Billroth-Ⅰ anastomosis and Roux-en-Y anastomosis in distal digestive tract reconstruction after distal gastrectomy by meta-analysis. Methods Randomized controlled trials (RCTs) with Billroth-Ⅰ anastomosis and Roux-en-Y anastomosis in the digestive tract reconstruction after distal gastrectomy were performed by using Embase, Pub Med, Med Line and The Cochrane Library. The search begins on December 1, 2015 and ends on March 1, 2016. The retrieved documents were screened according to the established inclusion and exclusion criteria, the quality of the included literature was evaluated using the modified Jadad scale, and the data analyzed using the Review Manager Version 5.1 software. Results A total of 600 RCT patients were enrolled in this study. Among them, 302 patients with Roux-en-Y anastomosis and 298 patients with Billroth-Ⅰ anastomosis were included. The results of the meta-analysis suggested that the Billroth-Ⅰ anastomoses at the time of surgery [WMD: 38.95; 95% CI: (19.86,58.04); p <0.0001] and intraoperative blood loss [WMD: 34.85; 95% CI: (2.13, 67.56 ); P = 0.04] had some advantages over Roux-en-Y anastomosis, but the patients who underwent Roux-en-Y anastomosis were better at preventing bile reflux (OR: 0.03; 95% CI: <0.000 01] and residual gastritis [OR: 0.37; 95% CI: (0.25, 0.54); P <0.000 01]. (OR = 0.43; 95% CI: (0.11, 1.68); P = 0.23], and anastomotic stenosis at admission (WMD: 2.96; 95% CI: (OR: 1.84; 95% CI: 0.61, 5.53; P = 0.27), reflux esophagitis [OR: 0.63; 95% CI: OR: 1.24; 95% CI: (0.46, 3.30); P = 0.67]. There was no significant difference in the anastomosis between Billroth-Ⅰ and Roux-en-Y. Conclusion The Billroth-Ⅰ anastomosis and the Roux-en-Y anastomosis have their own advantages and disadvantages. The Billroth-Ⅰ anastomosis is superior in safety, while the Roux-en-Y anastomosis is better in improving the quality of life of patients, More high-quality, well-designed, well-documented RCT literature for further validation.