| ObjectiveThrough the control study and data analysis,the effects of two kinds of digestive tract reconstruction of proximal gastric cancer on patients were evaluated in various aspects,such as operation duration,blood loss,postoperative complications,etc.,so as to provide more scientific,reliable and reasonable evidence for the selection of the operation when making clinical decisions.MethodsStrict inclusion and exclusion criteria were formulated and public search systems including PubMed,Springer,Wanfang Data and CQVIP were searched from January 2000 to June 2018.Combined with references in the found literatures,randomized controlled studies were selected to compare the clinical efficacy of Roux-en-Y and Double Tract reconstruction of digestive tract after proximal gastrectomy.The quality of the retrieved literature was assessed according to the "Risk of bias assessment" tool,which was recommended by the Cochrane collaboration.The final included studies were systematically evaluated quantitatively by Revman5.3 software.The main comparison indicators included time of surgery,intraoperative blood loss,length of hospital stay,incidence of complications,weight recovery and quality of life.Finally,Begg's is used to test the regression equation and calculate the coefficient of loss of safety to evaluate the publication bias.ResultsA total of 716 samples were included in 10 randomized controlled trials.This study conducted a meta-analysis of two methods of digestive tract reconstruction after proximal gastrectomy.The results showed that:(1)the operation time of the Double Tract reconstruction with preservation of gastric antrum and the Roux-en-Y reconstruction with total gastrectomy(WMD=0.34,95%CI[-13.01,13.70],P=0.96),intraoperative blood loss(WMD=9.40,95%CI[-10.94,29.74],P=0.36),hospitalization time(SMD=-0.18,95%CI[-0.40,0.04],P=0.10),postoperative leakage rate(OR=0.39,95%CI[0.13,1.14]),postoperative incisional infection rate(OR=0.93,95%CI[0.38,2.29],P=0.88),incidence of reflux esophagitis(OR=0.74,95%CI[0.35,1.57],P=0.44),incidence of anastomotic stoma stenosis(OR=0.72,95%CI[0.29,1.78],P=0.48),incidence of abdominal distension and diarrhea(OR=0.53,95%CI[0.23,1.19],P=0.12),1-year survival rate(OR=1.53,95%CI[0.60]),3-year survival rate(RD=0.03,95%ci[-0.12,0.18],P=0.68),and assessment of the patient's quality of life(SMD=-0.02,95%ci[-1.03,0.99],P=0.97).There were no statistically significant differences in all above variables.(2)Compared with the conventional Roux-en-Y anastomosis,Double Tract reconstruction with preserved gastric antrum can reduce the incidence of dumping syndrome(RD=-0.07,95%CI[-0.13,-0.02],P=0.01),and help the patient recover weight(SMD=-0.75,95%CI[-1.15,-0.35],P=0.0002).No obvious publication bias was indicated by P>0.1 under the Egger's Test.ConclusionCompared with Roux-en-Y reconstruction,the Double Tract reconstruction with the preservation of gastric antrum has more advantages in reducing the occurrence of dumping syndrome,promoting the recovery of weight and nutrition absorption in patients,and is a more reasonable reconstruction of digestive tract. |
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