Perivoliotis Konstantinos, Sioka Eleni, Tatsioni Athina, Stefanidis Ioannis, Zintzaras Elias, Zacharoulis Dimitrios
Department of Surgery, University Hospital of Larissa, Mezourlo, 41110 Larissa, Greece.
Postgraduate Programme (MSc): Research Methodology in Biomedicine, Biostatistics and Clinical Bioinformatics, University of Thessaly, Larissa, Greece.
Int J Surg Oncol. 2017;2017:7526494. doi: 10.1155/2017/7526494. Epub 2017 Jul 17.
A meta-analysis was conducted in order to provide an up-to-date comparison of pancreatogastrostomy (PG) and pancreatojejunostomy (PJ), after pancreatoduodenectomy (PD), in terms of clinically significant postoperative pancreatic fistula (POPF) and other postoperative complications.
This meta-analysis was conducted according to the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. A systematic literature search in MEDLINE and Cochrane Central Register of Controlled Clinical Trials was performed. Fixed Effects or Random Effects model was used, based on the Cochran test.
In total, 10 studies (1629 patients) were included. There was no statistical significance between PG and PJ regarding the rate of clinically significant POPF (OR: 0.70, 95%CI: 0.46-1.06). PG was associated with a higher rate of postpancreatoduodenectomy haemorrhage (PPH) (OR: 1.52, 95%CI: 1.08-2.14). There was no difference between the two techniques in terms of clinically significant PPH (OR: 1.35, 95%CI: 0.95-1.93) and clinically significant postoperative delayed gastric emptying (DGE) (OR: 0.98, 95%CI: 0.59-1.63).
There is no difference between the two anastomotic techniques regarding the rate of clinically significant POPF. Given several limitations, more large scale high quality RCTs are required.
为了对胰十二指肠切除术后胰胃吻合术（PG）和胰空肠吻合术（PJ）在临床上具有重要意义的术后胰瘘（POPF）及其他术后并发症方面进行最新比较，开展了一项荟萃分析。
本荟萃分析依据PRISMA指南和《Cochrane系统评价干预措施手册》进行。在MEDLINE和Cochrane临床对照试验中心注册库中进行了系统的文献检索。根据Cochran检验，采用固定效应模型或随机效应模型。
总共纳入了10项研究（1629例患者）。在具有临床意义的POPF发生率方面，PG和PJ之间无统计学差异（比值比：0.70，95%置信区间：0.46 - 1.06）。PG与胰十二指肠切除术后出血（PPH）发生率较高相关（比值比：1.52，95%置信区间：1.08 - 2.14）。在具有临床意义的PPH（比值比：1.35，95%置信区间：0.95 - 1.93）和具有临床意义的术后胃排空延迟（DGE）（比值比：0.98，95%置信区间：0.59 - 1.63）方面，两种技术之间无差异。
两种吻合技术在具有临床意义的POPF发生率方面无差异。鉴于存在若干局限性，需要更多大规模高质量的随机对照试验。
