胃切除术和肠吻合术式对胰十二指肠切除术后胃排空延迟的影响：一项随机试验的网络荟萃分析。
Impact of gastric resection and enteric anastomotic configuration on delayed gastric emptying after pancreaticoduodenectomy: a network meta-analysis of randomized trials.
机构信息
Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
HPB and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK.
出版信息
BJS Open. 2021 May 7;5(3). doi: 10.1093/bjsopen/zrab035.
INTRODUCTION
Delayed gastric emptying (DGE) is frequent after pancreaticoduodenectomy (PD). Several RCTs have explored operative strategies to minimize DGE, however, the optimal combination of gastric resection approach, anastomotic route, configuration and the use of enteroenterostomy remains unclear.
METHODS
MEDLINE, Embase and CENTRAL databases were systematically searched for RCTs comparing gastric resection (classic Whipple, pylorus-resecting, pylorus-preserving), anastomotic route (antecolic, retrocolic), configuration (loop gastroenterostomy/Billroth II, Roux-en-Y), and use of enteroenterostomy (Braun). A random-effects, Bayesian network meta-analysis with non-informative priors was conducted to determine the optimal combination of approaches to PD for minimizing DGE.
RESULTS
Twenty-four RCTs, including 2526 patients and 14 approaches were included. There was some heterogeneity, although inconsistency was low. The overall incidence of DGE was 25.6 per cent (647 patients). Pylorus-resecting, antecolic, Billroth II with Braun enteroenterostomy was associated with the lowest rates of DGE and ranked the best in 35 per cent of comparisons. Classic Whipple, retrocolic, Billroth II with Braun ranked the worst for DGE in 32 per cent of comparisons. Pairwise meta-analysis of retrocolic versus antecolic route for gastrojejunostomy found increased risk of DGE with the retrocolic route (odds ratio 2.10, 95 per cent credibility interval (cr.i.) 0.92 to 4.70). Pairwise meta-analysis of enteroenterostomy found a trend towards lower DGE rates when this was used (odds ratio 1.90, 95 per cent cr.i. 0.92 to 3.90). Having a Braun enteroenterostomy ranked the best in 96 per cent of comparisons.
CONCLUSION
Based on existing RCT evidence, a pylorus-resecting, antecolic, Billroth II with Braun enteroenterostomy seems to be associated with the lowest rates of DGE.
PREREGISTRATION
PROSPERO submitted 23 December 2020. CRD42021227637.
简介
胰腺十二指肠切除术（PD）后常发生胃排空延迟（DGE）。几项 RCT 探讨了手术策略以最大程度地减少 DGE，但胃切除术方法、吻合途径、构型和使用肠肠吻合术的最佳组合仍不清楚。
方法
系统检索了 MEDLINE、Embase 和 CENTRAL 数据库中的 RCT，比较了胃切除术（经典 Whipple、幽门切除术、保留幽门）、吻合途径（结肠前、结肠后）、构型（Loop 胃肠吻合术/Billroth II、Roux-en-Y）和使用肠肠吻合术（Braun）。采用具有非信息先验的随机效应贝叶斯网络荟萃分析来确定 PD 手术方法的最佳组合，以最大程度地减少 DGE。
结果
纳入 24 项 RCT，包括 2526 名患者和 14 种方法。存在一定程度的异质性，但不一致性较低。总体 DGE 发生率为 25.6%（647 例）。幽门切除术、结肠前、Billroth II 型加 Braun 肠肠吻合术与 DGE 发生率最低相关，在 35%的比较中排名最佳。经典 Whipple、结肠后、Billroth II 型加 Braun 肠肠吻合术在 32%的比较中排名最差。胃空肠吻合术结肠后与结肠前比较的成对荟萃分析发现，结肠后途径的 DGE 风险增加（比值比 2.10，95%可信区间（cr.i.）0.92 至 4.70）。肠肠吻合术的成对荟萃分析发现，使用肠肠吻合术时 DGE 发生率呈下降趋势（比值比 1.90，95% cr.i. 0.92 至 3.90）。使用 Braun 肠肠吻合术排名最佳，在 96%的比较中排名最佳。
结论
基于现有的 RCT 证据，幽门切除术、结肠前、Billroth II 型加 Braun 肠肠吻合术似乎与 DGE 发生率最低相关。
注册
PROSPERO 于 2020 年 12 月 23 日提交。CRD42021227637。
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