胰胃吻合术在预防胰十二指肠切除术后胰瘘方面优于胰空肠吻合术：一项随机对照试验的更新荟萃分析

Pancreaticogastrostomy is superior to pancreaticojejunostomy for prevention of pancreatic fistula after pancreaticoduodenectomy: an updated meta-analysis of randomized controlled trials.

作者信息

Menahem Benjamin, Guittet Lydia, Mulliri Andrea, Alves Arnaud, Lubrano Jean

机构信息

*Department of Digestive Surgery, University Hospital of Caen, Caen Cedex, France †Cancers and Prevention Laboratory, Research Department, University Hospital of Caen INSERM U 1086, Centre François Baclesse, Caen Cedex, France.

出版信息

Ann Surg. 2015 May;261(5):882-7. doi: 10.1097/SLA.0000000000000806.

DOI:10.1097/SLA.0000000000000806

PMID:24979604

Abstract

OBJECTIVE

To review prospective randomized controlled trials to determine whether pancreaticogastrostomy (PG) or pancreaticojejunostomy (PJ) is associated with lower risks of mortality and pancreatic fistula after pancreaticoduodenectomy (PD).

BACKGROUND

Previous studies comparing reconstruction by PG and PJ reported conflicting results regarding the relative risks of mortality and pancreatic fistula after these procedures.

METHODS

MEDLINE, the Cochrane Trials Register, and EMBASE were searched for prospective randomized controlled trials comparing PG and PJ after PD, published up to November 2013. Meta-analysis was performed using Review Manager 5.0.

RESULTS

Seven trials were selected, including 562 patients who underwent PG and 559 who underwent PJ. The pancreatic fistula rate was significantly lower in the PG group than in the PJ group (63/562, 11.2% vs 84/559, 18.7%; odds ratio = 0.53; 95% confidence interval, 0.38-0.75; P = 0.0003). The overall mortality rate was 3.7% (18/489) in the PG group and 3.9% (19/487) in the PJ group (P = 0.68). The biliary fistula rate was significantly lower in the PG group than in the PJ group (8/400, 2.0% vs 19/392, 4.8%; odds ratio = 0.42; 95% confidence interval, 0.18-0.93; P = 0.03).

CONCLUSIONS

In PD, reconstruction by PG is associated with lower postoperative pancreatic and biliary fistula rates.

摘要

目的

回顾前瞻性随机对照试验，以确定在胰十二指肠切除术（PD）后，胰胃吻合术（PG）或胰空肠吻合术（PJ）是否与更低的死亡风险和胰瘘风险相关。

背景

先前比较PG和PJ重建术的研究报告了这些手术术后死亡和胰瘘相对风险的相互矛盾的结果。

方法

检索MEDLINE、Cochrane试验注册库和EMBASE，查找截至2013年11月发表的比较PD后PG和PJ的前瞻性随机对照试验。使用Review Manager 5.0进行荟萃分析。

结果

选择了7项试验，包括562例行PG的患者和559例行PJ的患者。PG组的胰瘘发生率显著低于PJ组（63/562，11.2%对84/559，18.7%；优势比=0.53；95%置信区间，0.38 - 0.75；P = 0.0003）。PG组的总死亡率为3.7%（18/489），PJ组为3.9%（19/487）（P = 0.68）。PG组的胆瘘发生率显著低于PJ组（8/400，2.0%对19/392，4.8%；优势比=0.42；95%置信区间，0.18 - 0.93；P = 0.03）。