中国实用外科杂志

中国实用外科杂志

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姑息性手术与支架植入术治疗不可切除晚期胃癌疗效Meta分析

张文杰，徐    皓，徐泽宽   

  1. 南京医科大学第一附属医院普通外科 南京医科大学肿瘤个体化医学协同创新中心 江苏省科教强卫工程医学重点学科，江苏南京 210029
  • 出版日期:2017-10-01 发布日期:2017-10-11

  • Online:2017-10-01 Published:2017-10-11

摘要：

目的    评价姑息性胃空肠吻合与支架植入术在不可切除晚期胃癌胃出口梗阻病人中的安全性、有效性和疗效。方法    检索2017年8月前Pubmed、Elsevier、SPRINGER、Cochrane Library、中国期刊全文数据库、万方数据库、中国生物医学文献数据库数据库中对比姑息性胃空肠吻合和支架植入在晚期不可切除胃癌中应用的文献。按纳入标准筛选后进行质量评分，提取临床效应指标，采用Stata 12.0软件对所纳入的数据进行Meta分析。结果    共有13篇文献纳入分析。与支架植入组相比，胃空肠吻合组临床成功率高（OR=2.271，95%CI=1.539～3.352，P<0.001）、术后再梗阻发生率低（OR=0.351，95%CI=0.248～0.496，P<0.001）、术后胃出口通畅时间（WMD=243.386，95%CI=152.309~388.925，P<0.001）。而支架植入操作时间(WMD=112.548，95%CI=90.272～140.320，P<0.001)、术后进食时间（WMD=6.121，95%CI=4.616~8.118）和术后住院时间（WMD=14.208，95%CI=9.578~21.077，P<0.001）方面有优势。两组在操作相关死亡率及术后并发症发生率方面差异无统计学意义。结论    胃空肠吻合和内镜下支架植入对于晚期不可切除胃癌引起的胃出口梗阻都是安全有效的，对于预期生存时间较长病人建议行姑息性胃空肠吻合术。

关键词: 晚期胃癌, 姑息性胃空肠吻合术, 支架植入术, Meta分析

Abstract:

Comparison of the outcome of palliative therapy and endoscopic stenting in unresectable gastric cancer：A Meta-analysis        ZHANG Wen-jie，XU Hao，XU Ze-kuan. Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，China
Corresponding author：XU Ze-kuan，E-mail：xuzekuan@njmu.edu.cn
Abstract    Objective    To evaluate the safety and feasibility of palliative gastrojejunostomy (GJJ) and endoscopic stenting (ES) for gastric outlet obstruction (GOO) caused by unresectable gastric cancer. Methods    The literatures before August 2017 in Pubmed, Elsevier, SPRINGER, Cochrane Library, CNKI, CBM and Wanfang database were searched extensively to retrieve the comparative studies of palliative GJJ and ES in unresectable gastric cancer with a relevance of study goal. The inclusion and exclusion criteria were formulated. After a quality evaluation，the data were extracted. Meta-analysis was conducted by the Stata 12.0 software. Results    A total of thirteen studies met the inclusion criteria for meta-analysis．Compared with ES，the GJJ group had a higher rate of clinical success (OR=2.271，95%CI 1.539—3.352，P<0.001)，lower re-obstruction rate (OR=0.351，95%CI 0.248—0.496，P<0.001)，longer patency duration (WMD=243.386，95%CI 152.309—388.925，P<0.001). However，the ES group had a shorter procedure time （WMD=112.548，95%CI 90.272—140.320，P<0.001），faster resumption of oral intake（WMD=6.121，95%CI 4.616—8.118），and shorter duration of hospital stay（WMD=14.208，95%CI 9.578—21.077，P<0.001）. Procedure-related mortality and complications were not significantly different between the ES group and GJJ group. Conclusion    Both GJJ and ES are effective procedures for the treatment of GOO caused by gastric cancer. GJJ should be considered a treatment option for patients with a long life expectancy and good performance status.

Key words: advanced gastric cancer, palliative gastrojejunostomy, endoscopic stenting, Meta-analysis