Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
Study Centre of the German Surgical Society, University of Heidelberg, Heidelberg, Germany.
Br J Surg. 2017 May;104(6):660-668. doi: 10.1002/bjs.10505. Epub 2017 Mar 20.
Intra-abdominal drains are frequently used after pancreatic surgery whereas their benefit in other gastrointestinal operations has been questioned. The objective of this meta-analysis was to compare abdominal drainage with no drainage after pancreatic surgery.
PubMed, the Cochrane Library and Web of Science electronic databases were searched systematically to identify RCTs comparing abdominal drainage with no drainage after pancreatic surgery. Two independent reviewers critically appraised the studies and extracted data. Meta-analyses were performed using a random-effects model. Odds ratios (ORs) were calculated to aggregate dichotomous outcomes, and weighted mean differences for continuous outcomes. Summary effect measures were presented together with their 95 per cent confidence intervals.
Some 711 patients from three RCTs were included. The 30-day mortality rate was 2·0 per cent in the drain group versus 3·4 per cent after no drainage (OR 0·68, 95 per cent c.i. 0·26 to 1·79; P = 0·43). The morbidity rate was 65·6 per cent in the drain group and 62·0 per cent in the no-drain group (OR 1·17, 0·86 to 1·60; P = 0·31). Clinically relevant pancreatic fistulas were seen in 11·5 per cent of patients in the drain group and 9·5 per cent in the no-drain group. Reinterventions, intra-abdominal abscesses and duration of hospital stay also showed no significant difference between the two groups.
Pancreatic resection with, or without abdominal drainage results in similar rates of mortality, morbidity and reintervention.
胰腺手术后常使用腹腔引流，但其他胃肠道手术后引流的益处存在争议。本荟萃分析的目的是比较胰腺手术后引流与不引流的效果。
系统检索 PubMed、Cochrane 图书馆和 Web of Science 电子数据库，以确定比较胰腺手术后引流与不引流的 RCT。两名独立评审员对研究进行严格评估并提取数据。使用随机效应模型进行荟萃分析。使用比值比（OR）汇总二分类结局，使用加权均数差汇总连续结局。汇总效应量及其 95%置信区间一并呈现。
共有 3 项 RCT 的 711 名患者纳入分析。引流组的 30 天死亡率为 2.0%，无引流组为 3.4%（OR 0.68，95%CI 0.26 至 1.79；P=0.43）。引流组的发病率为 65.6%，无引流组为 62.0%（OR 1.17，0.86 至 1.60；P=0.31）。引流组中有 11.5%的患者出现临床相关的胰瘘，无引流组为 9.5%。再次干预、腹腔脓肿和住院时间在两组间也无显著差异。
胰腺切除术加或不加腹腔引流的死亡率、发病率和再次干预率相似。
