Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
Br J Surg. 2015 Mar;102(4):331-40. doi: 10.1002/bjs.9703. Epub 2015 Jan 29.
Postoperative pancreatic fistula is one of the most important and potentially severe complications after partial pancreaticoduodenectomy. In this context, the reduction of postoperative pancreatic fistula by means of a dual-loop (Roux-en-Y) reconstruction with isolation of the pancreaticojejunostomy from biliary drainage has been evaluated in several studies. This systematic review and meta-analysis summarizes evidence of effectiveness and safety of the isolation of the pancreaticojejunostomy compared with conventional single-loop reconstruction.
Randomized clinical trials (RCTs) and controlled clinical trials (CCTs) comparing outcomes of dual-loop reconstruction with isolated pancreaticojejunostomy and single-loop reconstruction were searched according to PRISMA guidelines. Random-effects meta-analyses were performed and the results presented as weighted risk ratios or mean differences with their corresponding 95 per cent c.i.
Of 83 trials screened for eligibility, three RCTs and four CCTs including a total of 802 patients were finally included. Quantitative synthesis showed no significant statistical difference between the two procedures regarding postoperative pancreatic fistula, delayed gastric emptying, haemorrhage, intra-abdominal fluid collection or abscess, bile leakage, wound infection, pneumonia, overall morbidity, mortality, reinterventions, reoperations, perioperative blood loss and length of hospital stay. Duration of surgery was significantly longer in patients undergoing dual-loop reconstruction.
Dual-loop (Roux-en-Y) reconstruction with isolated pancreaticojejunostomy after partial pancreaticoduodenectomy is not superior to single-loop reconstruction regarding pancreatic fistula rate or other relevant outcomes. Additional superiority trials are therefore not warranted, although a high-quality trial may be justified to prove equivalence or non-inferiority.
胰十二指肠部分切除术后胰瘘是最严重的并发症之一。在这种情况下，通过双环（Roux-en-Y）重建并将胰肠吻合口与胆肠引流隔离开来，已经在几项研究中评估了降低术后胰瘘的效果。本系统评价和荟萃分析总结了与传统单环重建相比，胰肠吻合口隔离的有效性和安全性证据。
根据 PRISMA 指南，检索了比较双环重建与胰肠吻合口隔离的单环重建的随机临床试验（RCT）和对照临床试验（CCT）。进行了随机效应荟萃分析，并以加权风险比或均值差及其相应的 95%置信区间表示结果。
在筛选出的 83 项试验中，最终纳入了 3 项 RCT 和 4 项 CCT，共 802 例患者。定量综合分析显示，两种手术方式在术后胰瘘、胃排空延迟、出血、腹腔积液或脓肿、胆漏、伤口感染、肺炎、总发病率、死亡率、再次干预、再次手术、围手术期失血和住院时间方面无显著统计学差异。接受双环重建的患者手术时间明显延长。
胰十二指肠部分切除术后胰肠吻合口双环（Roux-en-Y）重建并不优于单环重建，在胰瘘发生率或其他相关结局方面没有优势。因此，不需要进行额外的优势试验，尽管可能有必要进行高质量的试验来证明等效性或非劣效性。
