Zhang Xianbin, Dong Xin, Liu Peng, Yan Yumei, Wei Yushan, Zechner Dietmar, Gong Peng, Vollmar Brigitte
Institute for Experimental Surgery, Rostock University Medical Center, Rostock, Germany.
Dig Surg. 2017;34(4):265-280. doi: 10.1159/000453552. Epub 2017 Jan 18.
The aim of this study was to compare the safety and efficacy of a new technology, binding pancreaticojejunostomy (BPJ), with conventional pancreaticojejunostomy (CPJ) after pancreaticoduodenectomy in preventing postoperative pancreatic fistula (POPF).
Randomized controlled trials and observational studies were retrieved from literature searches. Pooled OR with 95% CI for dichotomous variables and weighted mean difference with 95% CI for continuous variables were calculated. Fixed-effect and random-effect models as well as subgroup analysis were used for sensitivity analysis.
No statistically significant differences were found in the incidence of POPF, delayed gastric emptying, postpancreatectomy hemorrhage, reoperation, morbidity, mortality, operation time, intraoperative blood loss, blood transfusion, and hospital stay between 2 groups. However, the total costs of hospitalization and ordinary stay were higher in BPJ group (€10,513 ± €6,536 vs. €8,238 ± €4,687, p = 0.002; €7,946 ± €5,023 vs. €5,700 ± €2,902, p = 0.015, respectively).
Our study showed BPJ was as safe as CPJ. However, no significant superiority was found in BPJ group regarding the incidence of POPF. The total costs of hospital stay were higher for patients undergoing BPJ. Surgeons can prefer to perform the digestive tract reconstruction of their choice.
本研究旨在比较一种新技术——捆绑式胰肠吻合术（BPJ）与传统胰肠吻合术（CPJ）在胰十二指肠切除术后预防术后胰瘘（POPF）方面的安全性和有效性。
通过文献检索获取随机对照试验和观察性研究。计算二分变量的合并OR值及95%置信区间，以及连续变量的加权均数差及95%置信区间。采用固定效应模型、随机效应模型以及亚组分析进行敏感性分析。
两组在POPF发生率、胃排空延迟、胰十二指肠切除术后出血、再次手术、发病率、死亡率、手术时间、术中失血量、输血及住院时间方面均未发现统计学上的显著差异。然而，BPJ组的住院总费用和普通住院天数更高（分别为10,513±6,536欧元 vs. 8,238±4,687欧元，p = 0.002；7,946±5,023欧元 vs. 5,700±2,902欧元，p = 0.015）。
我们的研究表明BPJ与CPJ一样安全。然而，在POPF发生率方面，BPJ组未发现明显优势。接受BPJ治疗的患者住院总费用更高。外科医生可选择进行他们所偏好的消化道重建方式。
