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Roux-en-Y versus BillrothⅠreconstruction after distal gastrectomy for gastric cancer:A meta-analysis

查看全文 作　　者：Jun-Jie [1]Xiong;Kiran [2]Altaf;Muhammad A [2]Javed;Quentin M [2]Nunes;Wei [2]Huang;Gang [1]Mai;Chun-Lu [1]Tan;Rajarshi [2]Mukherjee;Robert [2]Sutton;Wei-Ming [1]Hu;Xu-Bao [1]Liu 高影响力作者 机构地区：[1]Department of Hepato-Biliary-Pancreatic Surgery,West China Hospital,Sichuan University;[2]NIHR Liverpool Pancreas Biomedical Research Unit,Royal Liverpool University Hospital,University of Liverpool,Liverpool L69 3GA,Merseyside County,United Kingdom高影响力机构 出　　处：《World Journal of Gastroenterology》索引2013年第19卷第7期,共11页高影响力期刊 摘　　要：AIM:To conduct a meta-analysis to compare Rouxen-Y(R-Y) gastrojejunostomy with gastroduodenal Billroth Ⅰ(B-Ⅰ) anastomosis after distal gastrectomy(DG) for gastric cancer.METHODS:A literature search was performed to identify studies comparing R-Y with B-Ⅰ after DG for gastric cancer from January 1990 to November 2012 in Medline,Embase,Science Citation Index Expanded and the Cochrane Central Register of Controlled Trials in The Cochrane Library.Pooled odds ratios(OR) or weighted mean differences(WMD) with 95%CI were calculated using either fixed or random effects model.Operative outcomes such as operation time,intraoperative blood loss and postoperative outcomes such as anastomotic leakage and stricture,bile reflux,remnant gastritis,reflux esophagitis,dumping symptoms,delayed gastric emptying and hospital stay were the main outcomes assessed.Meta-analyses were performed using RevMan 5.0 software(Cochrane library).RESULTS:Four randomized controlled trials(RCTs) and 9 non-randomized observational clinical studies(OCS) involving 478 and 1402 patients respectively were included.Meta-analysis of RCTs revealed that R-Y reconstruction was associated with a reduced bile reflux(OR 0.04,95%CI:0.01,0.14;P < 0.00 001) and remnant gastritis(OR 0.43,95%CI:0.28,0.66;P = 0.0001),however needing a longer operation time(WMD 40.02,95%CI:13.93,66.11;P = 0.003).Metaanalysis of OCS also revealed R-Y reconstruction had a lower incidence of bile reflux(OR 0.21,95%CI:0.08,0.54;P = 0.001),remnant gastritis(OR 0.18,95%CI:0.11,0.29;P < 0.00 001) and reflux esophagitis(OR 0.48,95%CI:0.26,0.89;P = 0.02).However,this reconstruction method was found to be associated with a longer operation time(WMD 31.30,95%CI:12.99,49.60;P = 0.0008).CONCLUSION:This systematic review point towards some clinical advantages that are rendered by R-Y compared to B-Ⅰ reconstruction post DG.However there is a need for further adequately powered,welldesigned RCTs comparing the same. 关 键 词：Gastric cancer DISTAL GASTRECTOMY Rouxen-Y BILLROTH Ⅰ RECONSTRUCTION META-ANALYSIS
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