胰十二指肠切除术后胰胃吻合术与胰空肠吻合术对术后胰瘘发生率影响的Meta分析
Meta-analysis of pancreaticogastrostomy versus pancreaticojejunostomy on occurrences of postoperative pancreatic fistula after pancreaticoduodenectomy.
作者信息
Zhou Yanming, Yu Jianhua, Wu Lupeng, Li Bin
机构信息
Department of Hepatobiliary and Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Oncologic Center of Xiamen, Xiamen, China.
Department of Hepatobiliary and Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Oncologic Center of Xiamen, Xiamen, China.
出版信息
Asian J Surg. 2015 Jul;38(3):155-60. doi: 10.1016/j.asjsur.2015.02.002. Epub 2015 Apr 22.
BACKGROUND/OBJECTIVE: Pancreatic fistula (PF) is the most common and challenging complication after pancreaticoduodenectomy (PD). This meta-analysis aimed to evaluate the impact of pancreaticogastrostomy (PG) versus pancreaticojejunostomy (PJ) on occurrences of postoperative PF.
METHODS
A systematic literature search in the Medline, EMBASE, OVID, and Cochrane databases was performed to identify all eligible randomized controlled trials (RCTs). Pooled estimates were presented with 95% confidence intervals (CI).
RESULTS
Six RCTs involving 1005 patients met the inclusion criteria. The incidence of PF [odds ratio (OR) 0.58, 95% CI, 0.42-0.81; p = 0.001], intra-abdominal abscess or collections (OR 0.43, 95% CI, 0.28-0.65; p < 0.001), and biliary fistula (OR 0.28, 95% CI, 0.11-0.74; p = 0.01) were found to be significantly lower in the PG group than in the PJ group. There was no significant difference in overall morbidity, other complications, hospital mortality, or length of hospital stay between the two groups.
CONCLUSION
The meta-analysis showed that PG following PD represents a safe procedure associated with fewer PFs compared with PJ.
背景/目的：胰瘘（PF）是胰十二指肠切除术（PD）后最常见且具有挑战性的并发症。本荟萃分析旨在评估胰胃吻合术（PG）与胰空肠吻合术（PJ）对术后胰瘘发生率的影响。
方法
在Medline、EMBASE、OVID和Cochrane数据库中进行系统的文献检索，以识别所有符合条件的随机对照试验（RCT）。汇总估计值以95%置信区间（CI）表示。
结果
六项涉及1005例患者的RCT符合纳入标准。发现PG组的胰瘘发生率[比值比（OR）0.58，95%CI，0.42 - 0.81；p = 0.001]、腹腔内脓肿或积液（OR 0.43，95%CI，0.28 - 0.65；p < 0.001）和胆瘘（OR 0.28，95%CI，0.11 - 0.74；p = 0.01）明显低于PJ组。两组在总体发病率、其他并发症、医院死亡率或住院时间方面无显著差异。
结论
荟萃分析表明，与PJ相比，PD术后的PG是一种安全的手术，胰瘘较少。
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