Division of General Surgery, Florida Hospital Tampa, Tampa, FL, USA.
Division of General Surgery, Florida Hospital Tampa, Tampa, FL, USA.
Int J Surg. 2014;12(8):827-32. doi: 10.1016/j.ijsu.2014.06.008. Epub 2014 Jul 6.
Postoperative pancreatic fistula formation (POPF) remains one of the most common and detrimental complications following pancreaticojejunostomy (PJ). The aim of this meta-analysis is to analyze the efficacy of external pancreatic duct stent placement in preventing POPF formation following PJ.
The primary end-point was the incidence of POPF formation following pancreaticoduodenectomy (PD) in the presence and absence of external stent placement. Secondary outcomes examined were the incidence of perioperative mortality, delayed gastric emptying, postoperative wound infection, operative time, blood loss, and length of hospital stay.
Four trials were included comprising 416 patients. External pancreatic duct stenting was found to reduce the incidence of both any grade POPF formation (OR 0.37, 95% CI = 0.23 to 0.58, p = 0.0001) and clinically significant (grade B or C) POPF formation (OR 0.50, 95% CI = 0.30 to 0.84, p = 0.0009) following PD. The use of an external stent was also found to significantly lessen length of hospital stay (SMD -0.39, 95% CI = -0.63 to -0.15, p = 0.001).
This analysis has shown that external pancreatic duct stenting is indeed efficacious in the incidence of both any grade as well as clinically significant POPF formation following PD. Length of hospital stay was also found to be significantly less by external duct stenting.
胰肠吻合术后（PJ）胰瘘（POPF）仍然是最常见和最具危害性的并发症之一。本荟萃分析旨在分析外引流管支架置入术在预防 PJ 后 POPF 形成中的疗效。
主要终点是在存在和不存在外支架置入的情况下胰十二指肠切除术（PD）后 POPF 形成的发生率。次要结局检查包括围手术期死亡率、胃排空延迟、术后伤口感染、手术时间、失血量和住院时间。
共纳入 4 项试验，包括 416 例患者。外引流管支架置入可降低任何等级 POPF 形成的发生率（OR 0.37，95%CI=0.23 至 0.58，p=0.0001）和临床显著（B 级或 C 级）POPF 形成的发生率（OR 0.50，95%CI=0.30 至 0.84，p=0.0009）。使用外支架还可显著缩短住院时间（SMD-0.39，95%CI=-0.63 至-0.15，p=0.001）。
本分析表明，外引流管支架置入术确实能有效降低 PD 后任何等级和临床显著 POPF 形成的发生率。外引流管支架置入还可显著缩短住院时间。
