Department of Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Radiology, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein, University Medical Center Utrecht, Utrecht, The Netherlands.
Dig Dis Sci. 2023 Jul;68(7):3158-3166. doi: 10.1007/s10620-023-07929-x. Epub 2023 Apr 6.
Cholangitis is a late complication after pancreatoduodenectomy with considerable clinical impact and is difficult to treat. The aim of this systematic review was to provide an overview of the literature identifying risk factors for postoperative cholangitis.
A systematic search of the databases PUBMED and EMBASE was performed to identify all studies reporting on possible risk factors for cholangitis following pancreatoduodenectomy. Data on patient, peri- and postoperative characteristics were collected. Risk of bias assessment was done according to the methodological index for non-randomized studies (MINORS) criteria.
In total, 464 studies were identified. Eight studies met the inclusion criteria for this analysis. The definition of postoperative cholangitis was inconsistent, with four studies using the Tokyo Guidelines, whereas other studies used different definitions. Data on 26 potential risk factors concerning the patient, peri- and postoperative characteristics were analyzed. Five factors were significantly associated with cholangitis in two or more studies: high body mass index, duration of surgery, benign disease, postoperative pancreatic fistula, and postoperative serum alkaline phosphatase.
Multiple potential risk factors for postoperative cholangitis were identified, with large discrepancies between studies. Prospective research, with consensus on the definition, is required to determine the true relevance of these risk factors.
胆管炎是胰十二指肠切除术后的一种晚期并发症，具有重要的临床影响，且难以治疗。本系统评价的目的是提供文献综述，以确定胰十二指肠切除术后胆管炎的相关危险因素。
对 PUBMED 和 EMBASE 数据库进行系统检索，以确定所有报告胰十二指肠切除术后胆管炎可能危险因素的研究。收集患者、围手术期和术后特征的数据。根据非随机研究方法学指数 (MINORS) 标准进行偏倚风险评估。
共确定了 464 项研究。8 项研究符合本分析的纳入标准。术后胆管炎的定义不一致，四项研究采用东京指南，而其他研究则采用不同的定义。分析了 26 个与患者、围手术期和术后特征相关的潜在危险因素的数据。有五个因素在两个或更多研究中与胆管炎显著相关：高身体质量指数、手术时间、良性疾病、术后胰瘘和术后血清碱性磷酸酶。
确定了多个术后胆管炎的潜在危险因素，但研究之间存在较大差异。需要前瞻性研究，就定义达成共识，以确定这些危险因素的真正相关性。
