Department of Research & Development, St. Antonius Hospital, Nieuwegein, the Netherlands; Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Department of Research & Development, St. Antonius Hospital, Nieuwegein, the Netherlands; Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands.
Pancreatology. 2019 Oct;19(7):905-915. doi: 10.1016/j.pan.2019.08.006. Epub 2019 Aug 14.
Necrotizing pancreatitis may lead to loss of integrity of the pancreatic duct, resulting in leakage of pancreatic fluid. Pancreatic duct disruption or disconnection is associated with a prolonged disease course and particular complications. Since a standard treatment for this condition is currently lacking, we performed a systematic review of the literature to compare outcomes of various treatment strategies.
A systematic review was performed according to the PRISMA guidelines in the PubMed, EMBASE and Cochrane databases. Included were articles considering the treatment of patients with disrupted or disconnected pancreatic duct resulting from acute necrotizing pancreatitis.
Overall, 21 observational cohort studies were included comprising a total of 583 relevant patients. The most frequently used treatment strategies included endoscopic transpapillary drainage, endoscopic transluminal drainage, surgical drainage or resection, or combined procedures. Pooled analysis showed success rates of 81% (95%-CI: 60-92%) for transpapillary and 92% (95%-CI: 77-98%) for transluminal drainage, 80% (95%-CI: 67-89%) for distal pancreatectomy and 84% (95%-CI: 73-91%) for cyst-jejunostomy. Success rates did not differ between surgical procedures (cyst-jejunostomy and distal pancreatectomy (risk ratio = 1.06, p = .26)) but distal pancreatectomy was associated with a higher incidence of endocrine pancreatic insufficiency (risk ratio = 3.06, p = .01). The success rate of conservative treatment is unknown.
Different treatment strategies for pancreatic duct disruption and duct disconnection after necrotizing pancreatitis show high success rates but various sources of bias in the available studies are likely. High-quality prospective, studies, including unselected patients, are needed to establish the most effective treatment in specific subgroups of patients, including timing of treatment and long-term follow-up.
坏死性胰腺炎可能导致胰腺管完整性丧失，导致胰液泄漏。胰腺管破裂或断开与病程延长和特定并发症有关。由于目前缺乏这种疾病的标准治疗方法，我们对文献进行了系统评价，以比较各种治疗策略的结果。
根据 PRISMA 指南，在 PubMed、EMBASE 和 Cochrane 数据库中进行了系统评价。纳入的文章考虑了急性坏死性胰腺炎导致胰腺管破裂或断开的患者的治疗。
总共纳入了 21 项观察性队列研究，共纳入了 583 名相关患者。最常用的治疗策略包括内镜经胰管引流、内镜经腔道引流、手术引流或切除，或联合治疗。汇总分析显示，经胰管引流的成功率为 81%（95%CI：60-92%），经腔道引流的成功率为 92%（95%CI：77-98%），远端胰腺切除术的成功率为 80%（95%CI：67-89%），囊肿空肠吻合术的成功率为 84%（95%CI：73-91%）。手术治疗之间的成功率没有差异（囊肿空肠吻合术和远端胰腺切除术的风险比=1.06，p=0.26），但远端胰腺切除术与内分泌性胰腺功能不全的发生率较高（风险比=3.06，p=0.01）。保守治疗的成功率未知。
坏死性胰腺炎后胰腺管破裂和断开的不同治疗策略显示出较高的成功率，但现有研究中存在各种来源的偏倚。需要高质量的前瞻性研究，包括未选择的患者，以确定特定患者亚组中最有效的治疗方法，包括治疗时机和长期随访。
