消化管切除术后的缺口:一个系统的审查和元分析
Evgenia Mela1, Ioannis Katsaros2, Adam Mylonakis1
1First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str., 11527, Athens, Greece.
Esophagus : official journal of the Japan Esophageal Society
|December 25, 2025
概括
消化管切除术后缺口 (PEHH) 的报道越来越多,特别是在微创性消化管切除术 (MIE) 后. 肥胖可能是保护性的,而新辅助疗法增加了风险,需要个性化治疗策略.
科学领域:
- 胃肠病学 胃肠病学
- 手术瘤学手术瘤学
- 医学统计 医学统计
背景情况:
- 胃口切除术后的缺口 (PEHH) 是一种罕见但严重的并发症.
- 最少侵入性食道切除术 (MIE) 方法可能会增加PEHH的风险.
- 了解PEHH发生率和风险因素对于患者管理至关重要.
研究的目的:
- 系统地审查和元分析PEHH的发病率,风险因素,诊断和治疗方法.
- 为了确定与食道切除术后的PEHH发育相关的因素.
- 评估PEHH手术修复的结果.
主要方法:
- 在MEDLINE,Scopus和Cochrane数据库 (PRISMA指南) 中进行系统的文献搜索.
- 对34项研究的元分析,包括837例PEHH病例,以确定合并的赔率比率 (OR).
- 风险因素的评估,包括MIE,肥胖和新辅助化疗或放射治疗.
主要成果:
- 整体PEHH发生率为4.1%.
- MIE (OR:5.70) 和新辅助化学放射治疗 (OR:3.53) 与增加PEHH风险有关.
- 肥胖 (BMI > 25 kg/m2) 显著降低了PEHH的发生率 (OR:0.84).
- 在50.4%的病例中使用了微创性修复,发病率为31.7%,死亡率为2.1%.
结论:
- PEHH的发病率正在上升,MIE和新辅助疗法是显著的危险因素.
- 手术修复是症状PEHH的标准.
- 建议对无症状PEHH采取个性化的方法,考虑到癌症预后.
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