文献类型：期刊文献

中文题名：食管癌术后食管胃吻合口瘘危险因素的系统评价与Meta分析

英文题名：Risk factors for esophagogastric anastomotic leakage after esophageal cancer surgery: A systematic review and meta-analysis

作者：聂洪鑫[1,2];王兵[1];杨思豪[3];刘洪刚[3];孟辉[3]

第一作者：聂洪鑫

机构：[1]甘肃中医药大学研究生院,兰州730000;[2]中国人民解放军联勤保障部队第940医院心胸外科,兰州730000;[3]遵义医科大学第五附属医院心胸外科,广东珠海519100

第一机构：甘肃中医药大学党委研究生工作部、研究生院

年份：2022

卷号：29

期号：2

起止页码：166

中文期刊名：中国胸心血管外科临床杂志

外文期刊名：Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

收录：CSTPCD;;北大核心:【北大核心2020】；CSCD:【CSCD_E2021_2022】；

基金：甘肃中医药大学创新基金(2020CX46);2015年度原兰州军区基金资助项目A类(CLZ15JA04)。

语种：中文

中文关键词：吻合口瘘;食管癌;危险因素;系统评价/Meta分析

外文关键词：Anastomotic leakage;esophageal cancer;risk factors;systematic review/meta-analysis

摘要：目的系统评价食管癌术后食管胃吻合口瘘(esophagogastric anastomotic leakage,EGAL)的危险因素,为防治EGAL提供理论基础。方法通过计算机检索PubMed、Web of Science、The Cochrane Library、EMbase、万方、维普、中国知网和中国生物医学文献数据库,收集食管癌术后EGAL危险因素的病例对照研究、队列研究。检索时限均为建库至2020年1月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,使用RevMan 5.3软件进行Meta分析。结果共纳入33个研究,其中病例对照研究19个,队列研究14个,纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale,NOS)评分均≥6分。所有研究共包括26636例患者,其中男20283例、女6353例,国内9587例,国外17049例。Meta分析结果显示以下因素可增加食管癌术后EGAL的发生风险(P≤0.05):(1)患者自身因素(18个):年龄、性别、体重指数、吸烟史、吸烟指数(≥400年支)、饮酒史、消化道溃疡、呼吸系统疾病、第一秒用力呼气容积与用力肺活量比值(ratio of forced expiratory volume in one second to forced vital capacity,FEV1/FVC)、慢性阻塞性肺疾病(chronic obstructive pulmoriary disease,COPD)、冠状动脉粥样硬化、外周血管疾病、心律失常、糖尿病、高血压、脑血管疾病史、腹腔干钙化、降主动脉钙化;(2)术前因素(6个):肝功能异常、肾功能不全、美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级、新辅助放射治疗(放疗)、术前白蛋白<35 g/L、术前白蛋白低;(3)术中因素(7个):胸骨后途径、颈部吻合、胸腔镜手术、手术时间≥4.5 h、管状胃、上段肿瘤、脾切除;(4)术后因素(5个):呼吸衰竭、术后心律失常、使用纤维支气管镜、肺部感染、深静脉血栓。新辅助化学治疗(化疗)可降低术后EGAL的发生风险(P<0.05)。而年龄≥60岁、上消化道炎症、一氧化碳弥散量(diffusing capacity of carbon monoxide,DLCO)占预计值的比值(DLCO%)、胸部手术史、腹部手术史、糖皮质激素药物史、新辅助放射治疗和化学治疗、吻合口包埋、端端吻合、手工吻合、术中出血量等因素与食管癌术后EGAL的发生无明显相关性(P>0.05)。结论当前证据表明,食管癌术后发生EGAL的危险因素有年龄、性别、体重指数、吸烟指数、饮酒史、消化道溃疡、FEV1/FVC、COPD、糖尿病、ASA分级、新辅助放疗、术前白蛋白<35 g/L、颈部吻合、胸腔镜手术、手术时间≥4.5 h、管状胃、上段肿瘤、脾切除、术后呼吸衰竭、术后心律失常等,新辅助化疗可能是其保护因素。受纳入研究质量限制仍需要更多高质量的文献予以佐证。
Objective To systematically review risk factors for esophagogastric anastomotic leakage(EGAL)after esophageal cancer surgery for adults to provide theoretical basis for clinical prevention and treatment.Methods PubMed,Web of Science,The Cochrane Library,WanFang Data,VIP,CNKI and CBM were searched from inception to January2020 to collect case control studies and cohort studies about risk factors for EGAL after esophageal cancer surgery.Two reviewers independently screened literature,extracted data and assessed risk of bias of included studies,and then,metaanalysis was performed by using RevMan 5.3 software.Results A total of 33 studies were included,including 19 casecontrol studies and 14 cohort studies,all of which had a Newcastle-Ottawa Scale(NOS)≥6.There were 26636 patients,including 20283 males and 6353 females,and there were 9587 patients in China and 17049 patients abroad.The results of meta-analysis showed that the following factors could increase the risk for EGAL(P≤0.05),including patient factors(18):age,sex,body mass index(BMI),smoking history,smoking index(≥400),alcohol history,digestive tract ulcer,respiratory disease,lower ratio of forced expiratory volume in one second to forced vital capacity(FEV1/FVC),chronic obstructive pulmonary disease(COPD),coronary atherosclerosis,peripheral vascular disease,arrhythmia,diabetes,hypertension,cerebrovascular disease,celiac trunk calcification and descending aortic calcification;preoperative factors(6):abnormal liver function,renal insufficiency,American Society of Anesthesiologists(ASA)grading,neoadjuvant radiotherapy and preoperative albumin<35 g/L,preoperative lower albumin;intraoperative factors(7):retrosternal route,cervical anastomosis,thoracoscopic surgery,operation time≥4.5 h,tubular stomach,upper segment tumor,splenectomy;postoperative factors(5):respiratory failure,postoperative arrhythmia,use of fiberoptic bronchoscopy,pulmonary infection,deep venous thrombosis.Neoadjuvant chemotherapy could reduce the risk for postoperative EGAL(P<0.05).However,age≥60 years,upper gastrointestinal inflammation,diffusing capacity for carbon monoxide(DLCO%),thoracic surgery history,abdominal surgery history,glucocorticoid drugs history,neoadjuvant chemoradiotherapy,anastomotic embedding,end-to-end anastomosis,hand anastomosis,intraoperative blood loss and other factors were not significantly correlated with EGAL.Conclusion Current evidence suggests that the risk factors for postoperative EGAL include age,sex,BMI,smoking index,alcohol history,peptic ulcer,FEV1/FVC,COPD,diabetes,ASA grading,neoadjuvant radiotherapy,preoperative albumin<35 g/L,cervical anastomosis,thoracoscopic surgery,operation time≥4.5 h,tubular stomach,upper segment tumor,intraoperative splenectomy,postoperative respiratory failure,postoperative arrhythmia and other risk factors.Neoadjuvant chemotherapy may be the protection factor for EGAL.Due to limited study quality,more high quality studies are needed to verify the conclusion.