Huan Lu, Fei Qilin, Lin Huapeng, Wan Lun, Li Yue
Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Medicine (Baltimore). 2017 Dec;96(51):e9245. doi: 10.1097/MD.0000000000009245.
Our objective is to assess the function of peritoneal drainage, which is placed after pancreatic surgery.
With the medical advancement some study put forward that peritoneal drainage is not the necessary after pancreatic surgery; it cannot improve the complications of postoperation even leading to more infection and so on. However, there is no one study can clear and definite whether omitting the drainage after surgery or not.
Searching databases consist of all kinds of searching tools, such as Medline, The Cochrane Library, Embase, PubMed, etc. All the included studies should meet our demand of this meta-analysis. In the all interest outcomes blow we take the full advantage of RevMan5 to assess, the main measure is odds ratio (OR) with 95% confidence, the publication bias are assessed by Egger test and Begg test.
The rate of postoperative pancreatic fistula (POPF) in no drainage group is much lower than that in routine drainage group (OR = 0.47, I = 43%, P < .00001). The result of the 2 randomized controlled trials (RCTs) in this pool are almost accord with the former (OR = 0.57, I = 0%, P = .05). In subgroup the result suggest that the peritoneal drainage can increase the morbidity (OR = 0.71, I = 15%, P = .0002) after pancreaticoduodenectomy (PD), but reduce the mortality (OR = 1.92, I = 8%, P = .03) after PD. In distal pancreatectomy (DP) the rate of POPF and clinically relevant pancreatic fistula (CR-PF) is lower without drainage; there is no significant difference in the CR-PF, hospital stay, intra-abdominal abscess, radiologic invention, and the reoperation.
In the current meta-analysis, we cannot make a clear conclusion whether to abandon the routine drainage or not, but from the subgroup we can see something is safer than nothing to routine peritoneal drainage. And the patients who underwent DP can attempt to omit the drainage. But it still needs more RCTs to assess the necessity of drainage.
我们的目标是评估胰腺手术后放置的腹腔引流的功能。
随着医学的进步，一些研究提出胰腺手术后腹腔引流并非必要；它无法改善术后并发症，甚至会导致更多感染等情况。然而，尚无一项研究能够明确肯定术后是否省略引流。
检索由各种检索工具组成的数据库，如Medline、Cochrane图书馆、Embase、PubMed等。所有纳入研究均应符合我们本次荟萃分析的要求。在所有感兴趣的结果方面，我们充分利用RevMan5进行评估，主要测量指标为比值比（OR）及95%置信区间，通过Egger检验和Begg检验评估发表偏倚。
无引流组术后胰瘘（POPF）发生率远低于常规引流组（OR = 0.47，I = 43%，P <.00001）。该汇总分析中2项随机对照试验（RCT）的结果与前者基本一致（OR = 0.57，I = 0%，P =.05）。在亚组分析中，结果表明腹腔引流可增加胰十二指肠切除术（PD）后的发病率（OR = 0.71，I = 15%，P =.0002），但可降低PD后的死亡率（OR = 1.92，I = 8%，P =.03）。在远端胰腺切除术（DP）中，无引流时POPF和临床相关胰瘘（CR - PF）的发生率较低；CR - PF、住院时间、腹腔内脓肿、影像学发现及再次手术方面无显著差异。
在当前的荟萃分析中，我们无法明确得出是否应放弃常规引流的结论，但从亚组分析中可以看出，对于常规腹腔引流，有引流总比没有更安全。接受DP的患者可尝试省略引流。但仍需要更多的RCT来评估引流的必要性。
