Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
J Invest Surg. 2021 Jul;34(7):738-746. doi: 10.1080/08941939.2019.1691687. Epub 2020 Feb 25.
There is no specific evidence regarding the benefits of external and internal pancreatic duct stents after pancreaticoduodenectomy since pancreatic fistula (grade A) have been redefined with no clinical treatment effect. We aimed to reevaluate the prognostic value of external and internal stents in clinically relevant postoperative pancreatic fistula over pancreaticoduodenectomy.
PubMed, Web of Science, EMBASE and the Cochrane Database were specifically searched for pertinent and original articles published before May 2019. The project has been registered in PROSPERO (Registration number: CRD42019137579).
Four randomized controlled trials and six nonrandomized controlled trials with a total of 2101 patients were enrolled in this meta-analysis. The use of an external stent resulted in better performance than the use of an internal stent in terms of pancreatic fistula (grade C) (OR 0.58, = 0.03) but did not reduce the rate of pancreatic fistula (grade B) (OR 0.99, = 0.94) in all studies. The meta-analysis of randomized controlled trials found that the use of an external stent approached a level of significance for an increased rate of clinically relevant postoperative pancreatic fistula compared to the use of an internal stent (OR 1.40, = 0.10) but had no significant effect on pancreatic fistula (grade B) (OR 1.34, = 0.26) or pancreatic fistula (grade C) (OR 1.68, = 0.62).
Compared with internal stents, the use of external stent might be associated with a lower rate of pancreatic fistula (grade C). More randomized clinical trials are warranted to further explore safety and efficacy of pancreatic duct external stents.
由于胰瘘（A级）已经被重新定义，且没有临床治疗效果，因此对于胰十二指肠切除术后使用胰内外引流管的益处尚无确切证据。我们旨在重新评估胰十二指肠切除术后胰内外引流管在临床相关胰瘘中的预后价值。
我们专门检索了 PubMed、Web of Science、EMBASE 和 Cochrane 数据库，以获取 2019 年 5 月之前发表的相关且原创的文章。该项目已在 PROSPERO（注册号：CRD42019137579）中注册。
共有 4 项随机对照试验和 6 项非随机对照试验纳入了这项荟萃分析，共纳入 2101 例患者。与使用内支架相比，使用外支架在胰瘘（C 级）方面表现更好（OR 0.58，P=0.03），但并未降低所有研究中胰瘘（B 级）的发生率（OR 0.99，P=0.94）。随机对照试验的荟萃分析发现，与使用内支架相比，使用外支架可能会增加临床相关术后胰瘘的发生率（OR 1.40，P=0.10），但对胰瘘（B 级）（OR 1.34，P=0.26）或胰瘘（C 级）（OR 1.68，P=0.62）无显著影响。
与内支架相比，使用外支架可能与较低的胰瘘（C 级）发生率相关。需要更多的随机临床试验来进一步探讨胰管外支架的安全性和疗效。
