胰十二指肠切除术后的 Blumgart 吻合术：全面的系统评价、荟萃分析和荟萃回归。
Blumgart Anastomosis After Pancreaticoduodenectomy. A Comprehensive Systematic Review, Meta-Analysis, and Meta-Regression.
机构信息
Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, , S.Orsola-Malpighi Hospital, University of Bologna, Policlinico S.Orsola-Malpighi Via Massarenti n.9, 40138, Bologna, Italy.
Division of Pancreatic Surgery, Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia.
出版信息
World J Surg. 2021 Jun;45(6):1929-1939. doi: 10.1007/s00268-021-06039-x. Epub 2021 Mar 15.
BACKGROUND
The superiority of Blumgart anastomosis (BA) over non-BA duct to mucosa (non-BA DtoM) still remains under debate.
METHODS
We performed a systematic search of studies comparing BA to non-BA DtoM. The primary endpoint was CR-POPF. Postoperative morbidity and mortality, post-pancreatectomy hemorrhage (PPH), delayed gastric emptying (DGE), reoperation rate, and length of stay (LOS) were evaluated as secondary endpoints. The meta-analysis was carried out using random effect. The results were reported as odds ratio (OR), risk difference (RD), weighted mean difference (WMD), and number needed to treat (NNT).
RESULTS
Twelve papers involving 2368 patients: 1075 BA and 1193 non-BA DtoM were included. Regarding the primary endpoint, BA was superior to non-BA DtoM (RD = 0.10; 95% CI: -0.16 to -0.04; NNT = 9). The multivariate ORs' meta-analysis confirmed BA's protective role (OR 0.26; 95% CI: 0.09 to 0.79). BA was superior to DtoM regarding overall morbidity (RD = -0.10; 95% CI: -0.18 to -0.02; NNT = 25), PPH (RD = -0.03; 95% CI -0.06 to -0.01; NNT = 33), and LOS (- 4.2 days; -7.1 to -1.2 95% CI).
CONCLUSION
BA seems to be superior to non-BA DtoM in avoiding CR-POPF.
背景
布隆加特吻合术（BA）相较于非 BA 胆管黏膜吻合术（non-BA DtoM）的优势仍存在争议。
方法
我们对比较 BA 与 non-BA DtoM 的研究进行了系统检索。主要终点为 CR-POPF。次要终点包括术后发病率和死亡率、胰腺切除术后出血（PPH）、胃排空延迟（DGE）、再次手术率和住院时间（LOS）。使用随机效应进行荟萃分析。结果以优势比（OR）、风险差（RD）、加权均数差（WMD）和需要治疗的人数（NNT）表示。
结果
共纳入 12 篇文献，涉及 2368 例患者：1075 例 BA 和 1193 例 non-BA DtoM。主要终点方面，BA 优于 non-BA DtoM（RD=0.10；95%CI：-0.16 至 -0.04；NNT=9）。多变量 OR 荟萃分析证实了 BA 的保护作用（OR 0.26；95%CI：0.09 至 0.79）。BA 在总体发病率（RD=-0.10；95%CI：-0.18 至 -0.02；NNT=25）、PPH（RD=-0.03；95%CI：-0.06 至 -0.01；NNT=33）和 LOS（-4.2 天；-7.1 至 -1.2；95%CI）方面优于 DtoM。
结论
BA 似乎在避免 CR-POPF 方面优于 non-BA DtoM。
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