Dou Chang-Wei, Liu Zhi-Kui, Jia Yu-Li, Zheng Xin, Tu Kang-Sheng, Yao Ying-Min, Liu Qing-Guang
Chang-Wei Dou, Zhi-Kui Liu, Yu-Li Jia, Xin Zheng, Kang-Sheng Tu, Ying-Min Yao, Qing-Guang Liu, Department of Hepatobiliary Surgery, The First Affiliated Hospital of the Medical College of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.
World J Gastroenterol. 2015 May 14;21(18):5719-34. doi: 10.3748/wjg.v21.i18.5719.
To investigate whether prophylactic abdominal drainage is necessary after pancreatic resection.
PubMed, Web of Science, and the Cochrane Library were systematically searched to obtain relevant articles published before January 2014. Publications were retrieved if they met the selection criteria. The outcomes of interest included: mortality, morbidity, postoperative pancreatic fistula (POPF), clinically relevant pancreatic fistula (CR-PF), abdominal abscess, reoperation rate, the rate of interventional radiology drainage, and the length of hospital stay. Subgroup analyses were also performed for pancreaticoduodenectomy (PD) and for distal pancreatectomy. Begg's funnel plot and the Egger regression test were employed to assess potential publication bias.
Nine eligible studies involving a total of 2794 patients were identified and included in this meta-analysis. Of the included patients, 1373 received prophylactic abdominal drainage. A fixed-effects model meta-analysis showed that placement of prophylactic drainage did not have beneficial effects on clinical outcomes, including morbidity, POPF, CR-PF, reoperation, interventional radiology drainage, and length of hospital stay (Ps > 0.05). In addition, prophylactic drainage did not significantly increase the risk of abdominal abscess. Overall analysis showed that omitting prophylactic abdominal drainage resulted in higher mortality after pancreatectomy (OR = 1.56; 95%CI: 0.93-2.92). Subgroup analysis of PD showed similar results to those in the overall analysis. Elimination of prophylactic abdominal drainage after PD led to a significant increase in mortality (OR = 2.39; 95%CI: 1.22-4.69; P = 0.01).
Prophylactic abdominal drainage after pancreatic resection is still necessary, though more evidence from randomized controlled trials assessing prophylactic drainage after PD and distal pancreatectomy are needed.
探讨胰腺切除术后预防性腹腔引流是否必要。
系统检索PubMed、Web of Science和Cochrane图书馆，以获取2014年1月前发表的相关文章。符合入选标准的文献被纳入。感兴趣的结局包括：死亡率、发病率、术后胰瘘（POPF）、临床相关胰瘘（CR-PF）、腹腔脓肿、再次手术率、介入放射引流率和住院时间。还对胰十二指肠切除术（PD）和胰体尾切除术进行了亚组分析。采用Begg漏斗图和Egger回归检验评估潜在的发表偏倚。
共纳入9项符合条件的研究，涉及2794例患者。其中1373例患者接受了预防性腹腔引流。固定效应模型的Meta分析显示，预防性引流对临床结局无有益影响，包括发病率、POPF、CR-PF、再次手术、介入放射引流和住院时间（P>0.05）。此外，预防性引流并未显著增加腹腔脓肿的风险。总体分析显示，省略预防性腹腔引流会导致胰腺切除术后死亡率升高（OR = 1.56；95%CI：0.93 - 2.92）。PD的亚组分析结果与总体分析相似。PD术后取消预防性引流导致死亡率显著增加（OR = 2.39；95%CI：1.22 - 4.69；P = 0.01）。
胰腺切除术后预防性腹腔引流仍然必要，尽管需要更多来自评估PD和胰体尾切除术后预防性引流的随机对照试验的证据。
