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目的比较食管癌切除食管胃机械吻合与手工吻合术后并发症的发生率差异。方法计算机检索Medline(1960年1月至2015年6月)、EMbase(1980年1月至2015年6月)、Cochrane Library(1996年1月至2015年6月)、Web of Science(1980年1月至2015年6月),收集比较食管癌机械吻合和手工吻合对术后并发症发生率差异的随机对照试验(randomized controlled trial,RCT),并用Google Scholar等搜索引擎搜索参考文献。按照纳入和排除标准筛选后提取数据,采用Stata12.0软件进行Meta分析,用GRADE profiler 3.6软件进行证据质量评价。结果最终纳入14个RCT,包含1 611例患者。Meta分析结果显示,机械吻合组吻合口瘘发生率与手工吻合组差异无统计学意义[RR=1.07,95%CI(0.76,1.51),P=0.699],但吻合口狭窄的发生率要高于手工吻合组,差异有统计学意义[RR=1.59,95%CI(1.21,2.09),P=0.001]。结论机械吻合相对手工吻合对于食管癌术后吻合口瘘的发生率没有明显改善,而且会增加吻合口狭窄的发生率,临床医生要根据患者情况,慎重选择。
Objective To compare the differences in the incidence of postoperative esophagogastric esophagogastrostomy and manual anastomosis. METHODS: Medline (January 1960 to June 2015), EMbase (January 1980 to June 2015), Cochrane Library (January 1996 to June 2015), Web of Science (1980) Month to June 2015). Randomized controlled trials (RCTs) comparing mechanical postoperative complications of esophageal cancer and manual anastomosis were collected and searched by search engine such as Google Scholar. According to inclusion and exclusion criteria, the data were extracted after screening. Stata12.0 software was used for Meta analysis and GRADE profiler 3.6 software was used to evaluate the quality of evidence. The results eventually included 14 RCTs, including 1 611 patients. Meta analysis showed that the incidence of anastomotic fistula in mechanical anastomosis group was not significantly different from that in manual anastomosis group (RR = 1.07, 95% CI 0.76, 1.51, P = 0.699), but the incidence of anastomotic stenosis was higher In the manual anastomosis group, the difference was statistically significant [RR = 1.59,95% CI (1.21,2.09), P = 0.001]. Conclusion The mechanical anastomosis relative manual anastomosis for esophageal anastomotic leakage did not improve the incidence of postoperative anastomotic leakage, and will increase the incidence of anastomotic stenosis, clinicians should be based on the patient’s condition, carefully selected.