Nour Hussameldin M, Peristeri Dimitra V, Ahsan Amiya, Shafique Shehram, Khan Prof Mansoor, Sajid Muhammad S
Department of Digestive Disease and General Surgery, Royal Sussex County Hospital, UHSussex NHS Trust, Eastern Road Brighton BN2 5BE, UK.
Warwick Medical School, Medical School Building, Clifford Bridge Rd, Coventry, CV4 7HL, UK.
Ann Med Surg (Lond). 2022 Sep 14;82:104618. doi: 10.1016/j.amsu.2022.104618. eCollection 2022 Oct.
Post-pancreatectomy bleeding is a potentially fatal complication which results from the erosion of the regional visceral arteries, mainly the hepatic artery and stump of the gastro-duodenal artery, caused by a leak or fistula from the pancreatic anastomosis. The objective of this article is to assess whether wrapping of regional vessels with omentum or falciform/teres ligament following pancreaticoduodenectomy reduces the risk of extra-luminal bleeding.
Standard medical electronic databases were searched with the help of a local librarian and relevant published randomised controlled trials (RCT) and any type of comparative trial were shortlisted according to the inclusion criteria. The summated outcome of post-operative extra-luminal bleeding in patients undergoing pancreaticoduodenectomy was evaluated using the principles of meta-analysis on RevMan 5 statistical software.
Two RCTs and 5 retrospective studies on 4100 patients undergoing pancreaticoduodenectomy were found suitable for this meta-analysis. There were 1404 patients in the wrapping-group (WG) and 2696 patients in the no-wrapping group (NWG). In the random effects model analysis, the incidence of extra-luminal haemorrhage was statistically lower in WG [odds ratio 0.51, 95%, CI (0.31, 0.85), Z = 2.59, P = 0.01]. There was moderate heterogeneity between the studies; however it was not statistically significant.
The wrapping of regional vessels (using omentum, falciform ligament or ligamentum teres) following pancreaticoduodenectomy seems to reduce the risk of post-operative extra-luminal bleeding. However, more RCTs of robust quality recruiting a greater number of patients are required to validate these findings as this study presents the combined data of two RCTs and 5 retrospective studies.
胰十二指肠切除术后出血是一种潜在的致命并发症，是由胰腺吻合口漏或瘘导致区域内脏动脉（主要是肝动脉和胃十二指肠动脉残端）受侵蚀引起的。本文的目的是评估胰十二指肠切除术后用大网膜或镰状/圆韧带包裹区域血管是否能降低腔外出血的风险。
在当地图书馆员的帮助下检索标准医学电子数据库，并根据纳入标准筛选出相关的已发表随机对照试验（RCT）和任何类型的比较试验。使用RevMan 5统计软件的荟萃分析原理评估接受胰十二指肠切除术患者术后腔外出血的综合结果。
发现两项RCT和五项关于4100例接受胰十二指肠切除术患者的回顾性研究适合进行这项荟萃分析。包裹组（WG）有1404例患者，未包裹组（NWG）有2696例患者。在随机效应模型分析中，WG组腔外出血的发生率在统计学上较低[比值比0.51，95%置信区间（0.31，0.85），Z = 2.59，P = 0.01]。研究之间存在中度异质性；然而，在统计学上并不显著。
胰十二指肠切除术后包裹区域血管（使用大网膜、镰状韧带或圆韧带）似乎能降低术后腔外出血的风险。然而，由于本研究呈现的是两项RCT和五项回顾性研究的合并数据，因此需要更多高质量、纳入更多患者的RCT来验证这些发现。
