Meta-Analysis Of Risk Factors And Treatment Methods For Delayed Bleeding After Radical Gastrectomy

Objective:To explore the risk factors of delayed bleeding after radical gastrectomy.To compare the difference between anastomotic fistula and VP rupture in the causes of delayed hemorrhage after radical gastrectomy for gastric cancer.The therapeutic effects of TAE and secondary surgery on delayed hemorrhage after radical gastrectomy were compared and analyzed to provide clinical basis for prevention and treatment of delayed hemorrhage after radical gastrectomy.Method:Search the Pubmed database of the National Library of Medicine,the Medline database of the National Library of Medicine,the China Knowledge Network database,the Wanfang database,and the Weipu network.The search time is until December 2018,and a study on delayed bleeding after radical gastrectomy is published at home and abroad.After the two researchers independently screened the literature,extracted the data and evaluated the risk of bias in the included studies,the included literature was heterogeneously tested using Review Manager 5.3.3 software,and the combined OR values and 95%CI were calculated by meta-analysis.RESULTS:A total of 7 related literatures were included.The final case group included 89 patients with delayed blood samples and 8159 patients with radical surgery.In the comparison of distal gastrectomy and total gastrectomy for postoperative delayed bleeding,the heterogeneity test was P = 0.51.,12 = 0%,using a random effects model,OR = 1.22,95%CI:0.56-2.66,P = 0.62,the difference was not statistically significant.It can not be said that there is a difference in the probability of delayed bleeding after total gastrectomy and distal gastrectomy for radical cancer surgery.In the comparative study of gender factors,the heterogeneity test was P = 0.61,12 = 0%,and the fixed effect model,OR=0.88,95%CI:0.45-1.75,P = 0.72,indicating that gender differences in the delayed blood supply after radical gastrectomy were not statistically significant;In the staging comparison of tumors,the heterogeneity test showed P = 0.04,12 = 77%,and the random effects model,OR = 0.12,95%Cl:0.01-1.29,P = 0.08,the difference was not statistically significant.This indicates that tumor PTNM staging has little effect on delayed bleeding after radical gastrectomy;in addition,in the comparative study of the effect of ASA grading factors on delayed bleeding after radical surgery,the heterogeneity test P = 0.07,12 = 70%,Random effects model,OR = 33.97,95%CI:2.09-551.63,P = 0.01,the difference was statistically significant,indicating that ASA1+II is more prone to postoperative radical bleeding after ASAIII;rupture of VP(Visceral pseudoaneurysms)In the comparative study of bleeding and delayed bleeding caused by anastomotic leakage,the heterogeneity test showed P = 0.13.,12 = 44%,using a fixed effect model.OR = 1.23,95%CI:0.59-2.57,P = 0.58,difference Not statistically significant.In a comparative study of the success rate of TAE and surgical treatment,the heterogeneity test showed P = 0.13,I2 = 44%,using a fixed-effects model,OR = 3.76,95%CI:1.32-10.74,P = 0.01,and the difference was statistically significant.The significance of the study indicates that the treatment of delayed bleeding after radical gastrectomy is superior to TAE treatment.Conclusion:ASA grade ?+? is more likely to cause delayed hemorrhage after radical gastrectomy than ASA? grade;gender,tumor PTNM staging and resection methods have no significant effect;VP and anastomotic leakage cause delayed onset after radical gastrectomy The proportion of bleeding is quite equal;in the treatment of delayed bleeding,secondary surgery has an advantage over TAE.