Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei.
Br J Surg. 2015 Jan;102(1):4-15. doi: 10.1002/bjs.9653. Epub 2014 Nov 12.
Established closure techniques for the pancreatic remnant after distal pancreatectomy include stapler, suture and anastomotic closure. However, controversy remains regarding the ideal technique; therefore, the aim of this study was to compare closure techniques and risk of postoperative pancreatic fistula (POPF).
A systematic review was carried out according to PRISMA guidelines for studies published before January 2014 that compared at least two closure techniques for the pancreatic remnant in distal pancreatectomy. A random-effects model was constructed using weighted odds ratios (ORs).
Thirty-seven eligible studies matched the inclusion criteria and 5252 patients who underwent distal pancreatectomy were included. The primary outcome measure, the POPF rate, ranged 0 from to 70 per cent. Meta-analysis of the 31 studies comparing stapler versus suture closure showed that the stapler technique had a significantly lower rate of POPF, with a combined OR of 0.77 (95 per cent c.i. 0.61 to 0.98; P = 0.031). Anastomotic closure was associated with a significantly lower POPF rate than suture closure (OR 0.55, 0.31 to 0.98; P = 0.042). Combined stapler and suture closure had significantly lower POPF rates than suture closure alone, but no significant difference compared with stapler closure alone.
The use of stapler closure or anastomotic closure for the pancreatic remnant after distal pancreatectomy significantly reduces POPF rates compared with suture closure. The combination of stapler and suture closure shows superiority over suture closure alone.
胰体尾切除术后胰腺残端的传统关闭方法包括吻合器、缝线和吻合口关闭。然而，目前仍存在哪种方法更为理想的争议，因此，本研究旨在比较不同的胰腺残端关闭方法及其术后胰瘘（POPF）的风险。
根据 PRISMA 指南，对 2014 年 1 月前发表的比较胰体尾切除术胰腺残端至少两种关闭方法的研究进行了系统回顾。使用加权比值比（OR）构建随机效应模型。
符合纳入标准的 37 项研究共纳入 5252 例行胰体尾切除术的患者，POPF 发生率为 0 至 70%。31 项比较吻合器与缝线关闭的研究的 Meta 分析显示，吻合器技术的 POPF 发生率明显较低，合并 OR 为 0.77（95%可信区间 0.61 至 0.98；P = 0.031）。与缝线关闭相比，吻合口关闭的 POPF 发生率明显较低（OR 0.55，0.31 至 0.98；P = 0.042）。吻合器联合缝线关闭的 POPF 发生率明显低于单纯缝线关闭，但与单纯吻合器关闭无显著差异。
与缝线关闭相比，胰体尾切除术后胰腺残端使用吻合器或吻合口关闭可显著降低 POPF 发生率。吻合器联合缝线关闭优于单纯缝线关闭。
