Department of General Surgery, Affiliated Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Am J Surg. 2010 Oct;200(4):529-36. doi: 10.1016/j.amjsurg.2009.12.022. Epub 2010 Jun 9.
Suture closure and stapler closure of the pancreatic remnant after distal pancreatectomy are the techniques used most often. The ideal choice remains a matter of debate.
Five bibliographic databases covering 1970 to July 2009 were searched.
Sixteen articles met the inclusion criteria. Stapler closure was performed in 671 patients, while suture closure was conducted in 1,615 patients. The pancreatic fistula rate ranged from 0% to 40.0% for stapler closure of the pancreatic stump and from 9.3% to 45.7% for the suture closure technique. There were no significant difference between the stapler and suture closure groups with respect to the pancreatic fistula formation rate (22.1% vs 31.2%; odds ratio, .85; 95% confidence interval, .66-1.08), although there was a trend toward favoring stapler closure. In 4 studies including 437 patients, stapler closure was associated with a trend (not statistically significant) toward a reduction in intra-abdominal abscess (odds ratio, .53; 95% confidence interval, .24-1.15).
No significant differences occur between suture and stapler closure with respect to the pancreatic fistula or intra-abdominal abscess after distal pancreatectomy, though there is a trend favoring stapler closure.
胰腺残端的缝合关闭和切割吻合器关闭是远端胰腺切除术后最常使用的技术。然而，哪种方法是理想的选择仍存在争议。
检索了 1970 年至 2009 年 7 月的 5 个文献数据库。
符合纳入标准的文章有 16 篇。其中，671 例患者采用切割吻合器关闭胰腺残端，1615 例患者采用缝合关闭胰腺残端。胰腺残端切割吻合器关闭组的胰瘘发生率为 0%至 40.0%，缝合关闭组的胰瘘发生率为 9.3%至 45.7%。两组间的胰瘘发生率无显著差异（22.1%比 31.2%；比值比，0.85；95%置信区间，0.66-1.08），但倾向于切割吻合器关闭。在包括 437 例患者的 4 项研究中，切割吻合器关闭与腹腔脓肿发生率降低的趋势相关（无统计学意义）（比值比，0.53；95%置信区间，0.24-1.15）。
与缝合关闭相比，胰腺残端切割吻合器关闭在降低术后胰瘘和腹腔脓肿发生率方面无显著差异，但倾向于切割吻合器关闭。
