Dept. of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Dept. of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
HPB (Oxford). 2018 Sep;20(9):777-785. doi: 10.1016/j.hpb.2018.03.003.
Many pancreatic anastomoses have been proposed to reduce the incidence of postoperative pancreatic fistula (POPF) after pancreatoduodenectomy, but a complete overview is lacking. This systematic review and meta-analysis aims to provide an online overview of all pancreatic anastomosis techniques and to evaluate the incidence of clinically relevant POPF in randomized controlled trials (RCTs).
A literature search was performed to December 2017. Included were studies giving a detailed description of the pancreatic anastomosis after open pancreatoduodenectomy and RCTs comparing techniques for the incidence of POPF (International Study Group of Pancreatic Surgery [ISGPS] Grade B/C). Meta-analyses were performed using a random-effects model.
A total of 61 different anastomoses were found and summarized in 19 subgroups (www.pancreatic-anastomosis.com). In 6 RCTs, the POPF rate was 12% after pancreaticogastrostomy (n = 69/555) versus 20% after pancreaticojejunostomy (n = 106/531) (RR0.59; 95%CI 0.35-1.01, P = 0.05). Six RCTs comparing subtypes of pancreaticojejunostomy showed a pooled POPF rate of 10% (n = 109/1057). Duct-to-mucosa and invagination pancreaticojejunostomy showed similar results, respectively 14% (n = 39/278) versus 10% (n = 27/278) (RR1.40, 95%CI 0.47-4.15, P = 0.54).
The proposed online overview can be used as an interactive platform, for uniformity in reporting anastomotic techniques and for educational purposes. The meta-analysis showed no significant difference in POPF rate between pancreatic anastomosis techniques.
许多胰腺吻合术已被提出以降低胰十二指肠切除术后术后胰瘘（POPF）的发生率，但缺乏全面的综述。本系统评价和荟萃分析旨在提供所有胰腺吻合技术的在线概述，并评估随机对照试验（RCT）中临床相关 POPF 的发生率。
检索至 2017 年 12 月的文献。纳入研究详细描述了开放胰十二指肠切除术后的胰腺吻合术，并比较了 POPF 发生率的技术（国际胰腺外科研究组 [ISGPS] B/C 级）的 RCT。使用随机效应模型进行荟萃分析。
共发现 61 种不同的吻合术，并总结为 19 个亚组（www.pancreatic-anastomosis.com）。在 6 项 RCT 中，胰胃吻合术后 POPF 发生率为 12%（n=69/555），胰肠吻合术后为 20%（n=106/531）（RR0.59；95%CI 0.35-1.01，P=0.05）。6 项比较胰肠吻合术亚型的 RCT 显示，POPF 总发生率为 10%（n=109/1057）。导管黏膜吻合和套入式胰肠吻合术的结果相似，分别为 14%（n=39/278）和 10%（n=27/278）（RR1.40，95%CI 0.47-4.15，P=0.54）。
所提出的在线概述可用作一个互动平台，用于统一报告吻合技术和教育目的。荟萃分析显示，POPF 发生率在胰腺吻合技术之间没有显著差异。
