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目的系统评价食管上提径路为后纵隔径路与胸骨后径路对食管癌患者术后并发症的影响。方法计算机检索Pub Med、EMbase、CBM、VIP等数据库,检索时间从每个数据库创建至2014年4月,纳入后纵隔径路与胸骨后径路对食管癌患者术后并发症影响的随机对照试验和病例对照研究。评价纳入研究质量,提取数据,采用Rev Man 5.2软件进行Meta分析。结果共纳入23个研究,其中随机对照试验7个,病例对照研究16个。病例对照研究的Meta分析结果显示,两组术后吻合口瘘的发生率差异有统计学意义[OR=0.39,95%CI(0.30,0.50),P<0.01]。两组术后吻合口狭窄发生率差异无统计学意义[随机对照试验RR=0.80,95%CI(0.49,1.30),P=0.36;病例对照研究OR=0.64,95%CI(0.40,1.03),P=0.07]。两组术后心脏并发症发生率差异无统计学意义[随机对照试验RR=0.70,95%CI(0.46,1.06),P=0.09;病例对照研究OR=1.13,95%CI(0.70,1.81),P=0.62]。两组术后肺部并发症发生率差异无统计学意义[随机对照试验RR=1.27,95%CI(0.92,1.75),P=0.14;病例对照研究OR=0.91,95%CI0.66,1.27),P=0.59]。两组术后死亡率差异无统计学意义[随机对照试验RR=0.47,95%CI(0.19,1.16),P=0.10;病例对照研究OR=0.18,95%CI(0.03,1.01),P=0.05]。结论以食管上提径路为后纵隔径路比胸骨后径路术后吻合口瘘发生率较低。
Objective To evaluate the effect of esophageal ascending approach on postoperative complications of esophageal cancer patients treated by posterior mediastinal approach and posterior sternal approach. Methods The databases of Pub Med, EMbase, CBM and VIP were searched by computer. The data were collected from each database to April 2014 and included in the randomized controlled trials and cases of posterior mediastinal suture and posterior sternal pathology on postoperative complications of esophageal cancer patients Control study. Assess the quality of research, extract data, and perform meta-analysis using Rev Man 5.2 software. Results A total of 23 studies were included, including 7 randomized controlled trials and 16 case-control studies. Meta-analysis of case-control study showed that the incidence of anastomotic fistula was statistically different between two groups [OR = 0.39, 95% CI (0.30,0.50), P <0.01]. There was no significant difference in the incidence of anastomotic stenosis between the two groups [RR = 0.80, 95% CI (0.49, 1.30), P = 0.36 for case-control study OR = 0.64, 95% CI , P = 0.07]. There was no significant difference in the incidence of postoperative cardiac complications between the two groups (randomized controlled trial RR = 0.70, 95% CI 0.46, 1.06, P = 0.09; case-control study OR = 1.13, 95% CI 0.70, , P = 0.62]. There was no significant difference in the incidence of postoperative pulmonary complications between the two groups [RR = 1.27, 95% CI (0.92, 1.75), P = 0.14 for case-control study OR = 0.91, 95% CI 0.66, 1.27 ), P = 0.59]. There was no significant difference in the postoperative mortality between the two groups (randomized controlled trial, RR = 0.47, 95% CI, 0.11, P = 0.10); OR = 0.18, 95% CI 0.05]. Conclusion The esophageal approach to the posterior mediastinum pathology is lower than that after the sternal anastomosis fistula.