早期与延迟超声内镜引导下引流治疗术后胰腺液体积聚的系统评价和荟萃分析。
Early versus delayed EUS-guided drainage for postoperative pancreatic fluid collections: a systematic review and meta-analysis.
机构信息
Department of Gastroenterological Endoscopy, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan.
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
出版信息
Surg Endosc. 2024 Jan;38(1):47-55. doi: 10.1007/s00464-023-10568-y. Epub 2023 Nov 28.
BACKGROUND
Postoperative pancreatic fluid collections (POPFCs) are common adverse events (AEs) after pancreatic surgery and may need interventions. Endoscopic ultrasound (EUS)-guided drainage for POPFCs is increasingly reported, but its appropriate timing has not been fully elucidated. The aim of this meta-analysis was to evaluate treatment outcomes of POPFCs according to the timing of EUS-guided drainage.
METHODS
Using PubMed, Embase, Web of Science, and the Cochrane database, we identified clinical studies published until December 2022 with data comparing outcomes of early and delayed EUS-guided drainage for POPFCs. We pooled data on AEs, mortality, and technical and clinical success rates, using the random-effects model.
RESULTS
From 1415 papers identified in the initial literature search, we identified 6 retrospective studies, including 128 and 107 patients undergoing early and delayed EUS-guided drainage for POPFCs. The threshold of early and delayed drainage ranged from 14 to 30 days. Distal pancreatectomy was the major cause of POPFCs, ranging from 44 to 100%. The pooled odds ratio (OR) for AEs was 0.81 (95% confidence interval [CI] 0.40-1.64, P = 0.55) comparing early to delayed drainage. There was no procedure-related mortality. Technical success was achieved in all cases and a pooled OR of clinical success was 0.60 (95% CI 0.20-1.83, P = 0.37).
CONCLUSION
POPFCs can be managed by early EUS-guided drainage without an increase in AEs.
背景
胰腺手术后胰液漏（POPFC）是常见的不良事件（AE），可能需要干预。内镜超声（EUS）引导引流越来越多地用于治疗 POPFC，但其适当时机尚未完全阐明。本荟萃分析旨在评估根据 EUS 引导引流时机治疗 POPFC 的治疗结果。
方法
使用 PubMed、Embase、Web of Science 和 Cochrane 数据库，我们检索了截至 2022 年 12 月发表的比较早期和延迟 EUS 引导引流治疗 POPFC 结果的临床研究。我们使用随机效应模型汇总了 AE、死亡率以及技术和临床成功率的数据。
结果
从最初的文献搜索中确定了 1415 篇论文，我们确定了 6 项回顾性研究，其中 128 例和 107 例患者分别接受了早期和延迟 EUS 引导引流治疗 POPFC。早期和延迟引流的阈值范围为 14 至 30 天。胰体尾切除术是 POPFC 的主要原因，占 44%至 100%。与延迟引流相比，早期引流的 AE 比值比（OR）为 0.81（95%置信区间 [CI] 0.40-1.64，P=0.55）。没有与操作相关的死亡率。所有病例均达到技术成功，临床成功率的合并 OR 为 0.60（95%CI 0.20-1.83，P=0.37）。
结论
早期 EUS 引导引流可治疗 POPFC，不会增加 AE。
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