Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
Laboratory of Pathology, West China Hospital, Sichuan University, Chengdu, 610000, China.
Int J Surg. 2018 Aug;56:83-93. doi: 10.1016/j.ijsu.2018.06.012. Epub 2018 Jun 12.
Step-up therapy is the recommended therapy for infected necrotizing pancreatitis (INP). However, the most appropriate secondary therapy for use after initial drainage has not been fully determined. This meta-analysis was designed to evaluate the efficacy and safety of retroperitoneal versus open intraperitoneal necrosectomy as part of a step-up strategy for INP.
Eight online databases were searched for randomized controlled trials (RCTs) and cohorts comparing retroperitoneal and open intraperitoneal step-up approaches for treating INP. The data was pooled with a random-effects model.
A total of 21 controlled studies (one RCT and twenty cohorts) and 2177 patients were included in this study. Our meta-analysis showed that the retroperitoneal group had a lower postoperative complication rate [risk ratio (RR) = 0.575, 95% confidence interval (CI) = 0.459 to 0.719, P < 0.001], lower postoperative mortality (RR = 0.525, 95% CI = 0.430 to 0.642, P < 0.001), higher technical success rate (RR = 1.313, 95% CI = 1.017 to 1.694, P = 0.037), similar surgical reintervention rate (RR = 0.930, 95% CI = 0.783 to 1.106, P = 0.411), shorter operative time [standardized mean difference (SMD) = -2.402, 95% CI = -3.642 to -1.161, P < 0.001], and shorter hospital stay (SMD = -2.034, 95% CI = -3.041 to -1.026, P < 0.001) than the open group. These results were supported by a subgroup analysis.
For treating INP, the retroperitoneal approach is safer and more effective than the open intraperitoneal approach.
阶梯式治疗是感染性坏死性胰腺炎（INP）的推荐治疗方法。然而，尚未充分确定初始引流后使用的最合适的二级治疗方法。本荟萃分析旨在评估腹膜后与开放式腹腔内坏死切除术作为 INP 阶梯式策略的一部分的疗效和安全性。
检索了 8 个在线数据库，以查找比较腹膜后和开放式腹腔内阶梯式方法治疗 INP 的随机对照试验（RCT）和队列研究。使用随机效应模型对数据进行合并。
共有 21 项对照研究（1 项 RCT 和 20 项队列研究）和 2177 名患者纳入本研究。荟萃分析显示，腹膜后组术后并发症发生率较低[风险比（RR）=0.575，95%置信区间（CI）=0.459 至 0.719，P<0.001]，术后死亡率较低（RR=0.525，95%CI=0.430 至 0.642，P<0.001），技术成功率较高（RR=1.313，95%CI=1.017 至 1.694，P=0.037），手术再干预率相似（RR=0.930，95%CI=0.783 至 1.106，P=0.411），手术时间较短[标准化均数差（SMD）=-2.402，95%CI=-3.642 至-1.161，P<0.001]，住院时间较短（SMD=-2.034，95%CI=-3.041 至-1.026，P<0.001）。这些结果得到了亚组分析的支持。
对于治疗 INP，腹膜后方法比开放式腹腔内方法更安全、更有效。
