Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, 17 Changle Western Road, Xi'an, 710032 Shanxi Province, China.
World J Surg. 2011 Oct;35(10):2290-7. doi: 10.1007/s00268-011-1159-7.
Pancreatic fistula (PF) is an important factor responsible for the considerable morbidity associated with pancreaticoduodenectomy (PD). There have been many techniques proposed for the reconstruction of pancreatic digestive continuity to prevent fistula formation but which is best is still highly debated. We carried out a systematic review and meta-analysis to determine the effectiveness of methods of anastomosis after PD.
A full literature search was conducted in the Cochrane Controlled Trials Register Databases, Medline, and other resources irrespective of language. Randomized controlled trials (RCTs) were considered for inclusion. Analyses were carried out using RevMan software.
In all, ten RCTs that included a total of 1,408 patients were included. The meta-analysis showed that the PF, postoperative complications, biliary fistula, mortality, reoperation, and length of hospital stay were not statistically different between the pancreaticogastrostomy (PG) and pancreaticojejunostomy (PJ) groups. The PF, postoperative complications, mortality, and reoperation were not statistically different between the duct-to-mucosa PJ and PJ groups. Binding PJ significantly decreased the PF and postoperative complications compared with conventional PJ. The PF, postoperative complications, and mortality were not statistically different between ligation of the pancreatic duct without anastomosis versus PJ.
No pancreatic reconstruction technique after PD was found to be applicable to all kinds of pancreatic remnants in our systematic review and meta-analysis. Some new approaches such as binding PJ and modified PG will be considered for study in the future.
胰瘘（PF）是与胰十二指肠切除术（PD）相关的高发病率的重要因素。已经提出了许多用于重建胰腺消化连续性以防止瘘形成的技术，但哪种方法最好仍存在很大争议。我们进行了系统评价和荟萃分析，以确定 PD 后吻合方法的有效性。
在 Cochrane 对照试验注册数据库、Medline 和其他资源中进行了全面的文献检索，无论语言如何均纳入研究。纳入了随机对照试验（RCT）。使用 RevMan 软件进行分析。
共纳入了 10 项 RCT，总计纳入了 1408 例患者。荟萃分析显示，胰胃吻合术（PG）和胰肠吻合术（PJ）组之间的 PF、术后并发症、胆瘘、死亡率、再次手术和住院时间无统计学差异。胰管黏膜吻合术（PJ）和常规 PJ 组之间的 PF、术后并发症、死亡率和再次手术无统计学差异。与常规 PJ 相比，捆绑式 PJ 可显著降低 PF 和术后并发症。无吻合的胰管结扎与 PJ 相比，PF、术后并发症和死亡率无统计学差异。
在我们的系统评价和荟萃分析中，没有一种 PD 后重建技术被发现适用于所有类型的胰腺残端。未来将考虑一些新方法，如捆绑式 PJ 和改良 PG 进行研究。
