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1、ReviewDigSurg2011;28:29–35Publishedonline:February4,2011DOI:10.1159/000322014CervicalorThoracicAnastomosisafterEsophagectomyforCancer:ASystematicReviewandMeta-AnalysisS.S.A.Y. BiereK.W. MaasM.A. CuestaD.L. van der PeetDepartmentofSurgery,VUUniversityMedicalCenter,Am

2、sterdam,TheNetherlandsKeyWordsdomizedevidenceislimited.FurtherrandomizedtrialsareCervicalanastomosisThoracicanastomosisneededtoprovidesufficientevidenceforthepreferredloca-Esophagectomytionoftheanastomosisafteresophagectomy.Copyright©2011S.KargerAG,BaselAbstractBa

3、ckground:Cervicalanastomosisandthoracicanastomo-Introductionsisareusedforgastrictubereconstructionafteresophagec-tomyforcancer.ThissystematicreviewwasconductedinInthe1940sa72%perioperativemortalitywasassoci-ordertoidentifyrandomizedtrialsthatcomparecervicalatedwithe

4、sophagectomyforesophagealcancer[1].Inwiththoracicanastomosis.Methods:Aliteraturesearchfor1946,inordertoreducethismortality,IvorLewis[2]in-randomizedtrialswasperformedinthefollowingdatabases:troducedastandardizedapproachtoesophagealresec-Medline,EmbaseandtheCochraneL

5、ibrary.Results:Atotaltionforcarcinomaofthemiddlethirdoftheesophagus.of4trialswereincluded.AllstudieshadasmallsamplesizeThisapproachinvolveda2-stageprocedurethatincludedandwereofmoderatequality.Onetrialwasexcludedfromalaparotomy,withathoracotomywiththoracicanasto-the

6、meta-analysis.Thefollowingoutcomesweresignificant-mosis1–2weekslater.Theriskofanastomoticleakageinlyassociatedwithacervicalanastomosis:recurrentlaryn-thethoraxwithfatalconsequencesresultedina3-stagegealnervetrauma(OR:7.14;95%CI:1.75–29.14;p=0.006)andapproachwithacer

7、vicalanastomosis[3].Incaseofleak-anastomoticleakage(OR:3.43;95%CI:1.09–10.78;p=0.03).age,acervicalfistulaisamanageablecomplication[4].NoneofthefollowingoutcomeswereassociatedwiththeHowever,anincreasedincidenceofleakageandstricturelocationoftheanastomosis:pulmonaryco

8、mplications(OR:formationcouldbeassociatedwithacervicalanasto-0.86;95%CI:0.13–5.59;p=0.87),perioperativemortality(OR:mosis.1.24;95%CI:0.35–