胰十二指肠切除术后诊断为术后胰瘘后手术引流管理的系统评价和荟萃分析：引流道靶向治疗优于标准治疗。
Systematic review and meta-analysis of surgical drain management after the diagnosis of postoperative pancreatic fistula after pancreaticoduodenectomy: draining-tract-targeted works better than standard management.
机构信息
Università degli Studi di Padova, Via Crescini, 39, 35126, Padua, Italy.
Dipartimento di Scienze Statistiche, Università degli Studi di Padova, Padua, Italy.
出版信息
Langenbecks Arch Surg. 2020 Dec;405(8):1219-1231. doi: 10.1007/s00423-020-02005-8. Epub 2020 Oct 26.
PURPOSE
Drains' role after pancreaticoduodenectomy (PD) is debated by proponents of no drain, draining selected cases, and early drain removal. The aim of the study was to assess the effect of "standard" and "draining-tract-targeted" management of abdominal drains still in situ after diagnosing a postoperative pancreatic fistula (POPF).
METHODS
PubMed and Scopus were searched for "pancreaticoduodenectomy or pancreatoduodenectomy or duodenopancreatectomy," "Whipple," "proximal pancreatectomy," "pylorus-preserving pancreatectomy," and "postoperative pancreatic fistula or POPF.". Main outcomes included clinically relevant (CR) POPF, grade-C POPF, overall mortality, POPF-related mortality, and CR-POPF-related mortality. Secondary outcomes were incidence of radiological and/or endoscopic interventions, reoperations, and completion pancreatectomies.
RESULTS
Overall, 12,089 studies were retrieved by the search of the English literature (01/01/1990-31/12/2018). Three hundred and twenty-six studies (90,321 patients) reporting ≥ 100 PDs and ≥ 10 PD/year were finally included into the study. Average incidences were obtained by averaging the incidence rates reported in the single articles. Pooled incidences were calculated by combining the number of events and the total number of patients considered in the various studies. These were then meta-analyzed using DerSimonian and Laird's (1986) method. Pearson's chi-squared test was used to compare pooled incidences between groups. Post hoc testing was used to see which groups differed. The meta-analyzed incidences were compared using a fixed effect for moderators. "Draining-tract-targeted" management showed a significant advantage over "standard" management in four clinically relevant outcomes out of eight according to pool analysis and in one of them according to meta-analysis.
CONCLUSION
Clinically, "draining-targeted" management of POPF should be preferred to "standard" management.
目的
在诊断胰十二指肠切除术后胰瘘（POPF）后，引流管的作用存在争议，支持者分别认为无需引流、选择性引流以及早期拔管。本研究旨在评估在诊断术后胰瘘后仍保留原位的“标准”和“引流管靶向”管理方式对腹部引流管的影响。
方法
在 PubMed 和 Scopus 中检索“胰十二指肠切除术或胰十二指肠切除术或胰头十二指肠切除术、Whipple、胰头切除术、保留幽门的胰头切除术”和“术后胰瘘或 POPF”。主要结局包括临床相关（CR）POPF、C 级 POPF、总死亡率、POPF 相关死亡率和 CR-POPF 相关死亡率。次要结局为影像学和/或内镜干预、再次手术和完成胰切除术的发生率。
结果
通过对英文文献的搜索（1990 年 1 月 1 日至 2018 年 12 月 31 日），共检索到 12089 项研究。最终纳入 326 项研究（90321 例患者），这些研究报告了≥100 例 PD 手术和≥10 例/年。通过对单篇文章报告的发病率进行平均计算得出平均发病率。通过合并各研究中事件数量和总患者数量计算得出合并发病率。然后使用 DerSimonian 和 Laird（1986）的方法对其进行荟萃分析。使用 Pearson 卡方检验比较组间的合并发病率。进行事后检验以观察哪些组存在差异。使用固定效应对调节因素进行荟萃分析。根据汇总分析，与“标准”管理相比，“引流管靶向”管理在 8 个临床相关结局中的 4 个和 1 个结局中有显著优势。
结论
在临床上，“引流管靶向”管理应优先于“标准”管理用于 POPF。
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