Department of General Surgery, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK.
Department of General Surgery, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK; Rowett Institute of Nutrition and Health, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK.
Hepatobiliary Pancreat Dis Int. 2020 Apr;19(2):116-121. doi: 10.1016/j.hbpd.2019.12.007. Epub 2020 Jan 9.
Severe acute pancreatitis is a common diagnosis in emergency general surgery and can be a cause of significant morbidity and mortality. A consequence of severe acute pancreatitis is thrombus in the splanchnic veins. These thrombi can potentially lead to bowel ischemia or hepatic failure. However, another complication of severe acute pancreatitis is retroperitoneal bleeding. At this time, it is unclear if treating patients for splanchnic vein thrombosis in the context of severe acute pancreatitis is associated with any outcome benefit. A systematic review might clarify this question.
A two-fold search strategy (one broad and one precise) looked at all published literature. The review was registered on PROSPERO (ID: CRD42018102705). MEDLINE, EMBASE, PubMed, Cochrane and Web of Science databases were searched and potentially relevant papers were reviewed independently by two researchers. Any disagreement was reviewed by a third independent researcher. Primary outcome was reestablishment of flow in the thrombosed vein versus bleeding complications.
Of 1462 papers assessed, a total of 16 papers were eligible for inclusion. There were no randomized controlled trials, 2 were case series, 5 retrospective single-center studies and 9 case reports. There were a total of 198 patients in these studies of whom 92 (46.5%) received anticoagulation therapy. The rates of recanalization of veins in the treated and non-treated groups was 14% and 11% and bleeding complications were 16% and 5%, respectively. However, the included studies were too heterogeneous to undertake a meta-analysis.
The systematic review highlights the lack evidence addressing this clinical question. Therefore a randomized controlled trial would be appropriate to undertake.
重症急性胰腺炎是普通的急症外科诊断，可能导致显著的发病率和死亡率。重症急性胰腺炎的一个后果是内脏静脉血栓形成。这些血栓可能导致肠缺血或肝功能衰竭。然而，重症急性胰腺炎的另一个并发症是腹膜后出血。目前，尚不清楚在重症急性胰腺炎的情况下治疗内脏静脉血栓形成是否会带来任何获益。系统评价可能会澄清这个问题。
采用双重搜索策略（一个广泛，一个精确）搜索所有已发表的文献。该综述已在 PROSPERO（注册号：CRD42018102705）上注册。检索了 MEDLINE、EMBASE、PubMed、Cochrane 和 Web of Science 数据库，并由两位研究人员独立审查了潜在相关的论文。任何分歧都由第三位独立研究员进行审查。主要结果是血栓静脉再通与出血并发症的比较。
在评估的 1462 篇论文中，共有 16 篇论文符合纳入标准。没有随机对照试验，有 2 篇病例系列，5 篇回顾性单中心研究和 9 篇病例报告。这些研究共纳入了 198 例患者，其中 92 例（46.5%）接受了抗凝治疗。在接受和未接受治疗的患者中，静脉再通率分别为 14%和 11%，出血并发症发生率分别为 16%和 5%。然而，纳入的研究存在很大的异质性，无法进行荟萃分析。
系统评价强调了缺乏解决这一临床问题的证据。因此，进行随机对照试验是合适的。
