胰十二指肠切除术后新发糖尿病：一项系统评价与荟萃分析。

New-onset diabetes after pancreatoduodenectomy: A systematic review and meta-analysis.

作者信息

Scholten Lianne, Mungroop Timothy H, Haijtink Simone A L, Issa Yama, van Rijssen L Bengt, Koerkamp Bas Groot, van Eijck Casper H, Busch Olivier R, DeVries J Hans, Besselink Marc G

机构信息

Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, the Netherlands.

Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands.

出版信息

Surgery. 2018 May 17. doi: 10.1016/j.surg.2018.01.024.

DOI:10.1016/j.surg.2018.01.024

PMID:29779868

Abstract

BACKGROUND

Pancreatoduodenectomy may lead to new-onset diabetes mellitus, also known as type 3c diabetes, but the exact risk of this complication is unknown. The aim of this review was to assess the risk of new-onset diabetes mellitus after pancreatoduodenectomy.

METHODS

A literature search was performed in PubMed, Embase (Ovid), and the Cochrane Library for English articles published from March 1993 until March 2017 (PROSPERO registry number: CRD42016039784). Studies reporting on the risk of new-onset diabetes mellitus after pancreatoduodenectomy were included. For meta-analysis, studies were pooled using the random-effects model. All studies were appraised according to the Newcastle-Ottawa Scale.

RESULTS

After screening 1,523 studies, 22 studies involving 1,121 patients were eligible. The mean weighted overall proportion of new-onset diabetes mellitus after pancreatoduodenectomy was 16% (95% confidence interval, 12%-20%). We found no significant difference in risk of new-onset diabetes mellitus when pancreatoduodenectomy was performed for nonmalignant disease after excluding patients with chronic pancreatitis (19% risk; 95% confidence interval, 7%-43%; 6 studies) or for malignant disease (22% risk; 95% confidence interval, 14%-32%; 11 studies), P = .71. Among all patients, 6% (95% confidence interval, 4%-10%) developed insulin-dependent new-onset diabetes mellitus.

CONCLUSION

This systematic review identified a clinically relevant risk of new-onset diabetes mellitus after pancreatoduodenectomy of which patients should be informed preoperatively.

摘要

背景

胰十二指肠切除术可能导致新发糖尿病，也称为3c型糖尿病，但这种并发症的确切风险尚不清楚。本综述的目的是评估胰十二指肠切除术后新发糖尿病的风险。

方法

在PubMed、Embase（Ovid）和Cochrane图书馆中检索1993年3月至2017年3月发表的英文文章（PROSPERO注册号：CRD42016039784）。纳入报告胰十二指肠切除术后新发糖尿病风险的研究。对于荟萃分析，采用随机效应模型对研究进行汇总。所有研究均根据纽卡斯尔-渥太华量表进行评估。

结果

在筛选了1523项研究后，22项涉及1121例患者的研究符合条件。胰十二指肠切除术后新发糖尿病的平均加权总体比例为16%（95%置信区间，12%-20%）。在排除慢性胰腺炎患者后，对非恶性疾病进行胰十二指肠切除术（风险为19%；95%置信区间，7%-43%；6项研究）或对恶性疾病进行胰十二指肠切除术（风险为22%；95%置信区间，14%-32%；11项研究）时，我们发现新发糖尿病风险无显著差异，P = 0.71。在所有患者中，6%（95%置信区间4%-10%）发生了胰岛素依赖型新发糖尿病。