Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan-Jiang Xi Road, GuangZhou, 510120, China.
J Gastrointest Surg. 2012 Dec;16(12):2322-35. doi: 10.1007/s11605-012-1987-2.
The use of pancreatic duct stent to improve postoperative outcomes of pancreatic anastomosis remains a matter of debate, and the value of stenting when performing anastomosis for normal pancreas (soft and duct less than 3 mm) needs further study. The aim of the present meta-analysis was to evaluate the perioperative outcomes of patients with stenting during pancreatic anastomosis and compare the effect of external stent with that of internal stent indirectly.
A systematic literature search (EMBASE, MEDLINE, PubMed, The Cochrane Library, and Web of Science) was performed to identify studies evaluating external stent or internal stent. Included literature was assessed and extracted by two independent reviewers. A meta-analysis including comparative studies providing data on patients with and without external stenting or internal stenting during pancreaticojejunostomy anastomosis was performed.
Thirteen articles including 1,867 patients were identified for inclusion: five randomized controlled trials study and eight observational clinical studies. Meta-analyses revealed that use of external stent was associated with a significantly decreased risk for pancreatic fistula in total (odds ratio (OR) 0.47; 95 % confidence interval (CI) 0.31-0.71; P = 0.0004; I (2) = 3 %), pancreatic fistula in normal pancreas(OR 0.5; 95 % CI 0.30-0.82; P = 0.007; I (2) = 5 %), and overall morbidity(OR 0.64; 95 % CI 0.45-0.90; P = 0.01; I (2) = 0 %); however, the meta-analysis showed that there were no significant differences between internal stenting and non-stenting groups as regards perioperative outcomes and that in fact it may increase pancreatic fistula rate in normal pancreas(OR 1.97; 95 % CI 1.05-3.69; P = 0.03; I (2) = 0 %).
The results of this analysis demonstrate a trend toward reduced pancreatic fistula with the use of external pancreatic stents in pancreaticojejunostomy. An internal stent does not impact development of fistula and that in fact it was not useful in a soft pancreas. Our conclusion may be limited to stenting during the duct-to-mucosa pancreaticojejunostomy anastomosis, and the value of stenting during invagination anastomosis needs further study.
使用胰管支架来改善胰吻合术后的结果仍然存在争议，在进行正常胰腺（柔软且胰管小于 3 毫米）吻合时，支架的价值需要进一步研究。本荟萃分析的目的是评估胰吻合术中支架置入患者的围手术期结果，并间接比较外支架和内支架的效果。
对 EMBASE、MEDLINE、PubMed、The Cochrane Library 和 Web of Science 进行系统文献检索，以确定评估外支架或内支架的研究。由两名独立评审员评估和提取纳入文献。对包括提供胰肠吻合术时有无外支架或内支架置入患者数据的比较研究进行荟萃分析。
共确定了 13 篇纳入的文献，包括 1867 例患者：5 项随机对照试验研究和 8 项观察性临床研究。荟萃分析显示，使用外支架显著降低了总胰瘘（比值比 (OR) 0.47；95%置信区间 (CI) 0.31-0.71；P=0.0004；I (2) = 3%）、正常胰腺胰瘘（OR 0.5；95%CI 0.30-0.82；P=0.007；I (2) = 5%）和总并发症发生率（OR 0.64；95%CI 0.45-0.90；P=0.01；I (2) = 0%）的风险；然而，荟萃分析显示，内支架和非支架组在围手术期结果方面没有显著差异，实际上它可能会增加正常胰腺的胰瘘发生率（OR 1.97；95%CI 1.05-3.69；P=0.03；I (2) = 0%）。
本分析结果表明，在胰肠吻合术中使用外胰腺支架可降低胰瘘的发生趋势。内支架不会影响瘘的发生，实际上在柔软的胰腺中它没有用处。我们的结论可能仅限于乳头肌黏膜胰肠吻合术时的支架置入，套入式吻合术时支架的价值需要进一步研究。
