部分胰腺切除术后人工或自体覆盖残胰或吻合口对术后胰瘘的影响：随机临床试验的荟萃分析。

Effect of artificial or autologous coverage of the pancreatic remnant or anastomosis on postoperative pancreatic fistulas after partial pancreatectomy: meta-analysis of randomized clinical trials.

机构信息

Department of Surgery, Cantonal Hospital Thurgau, Münsterlingen, Switzerland.

Study Centre of the German Society of Surgery (SDGC), University of Heidelberg, Heidelberg, Germany.

出版信息

BJS Open. 2024 May 8;8(3). doi: 10.1093/bjsopen/zrae059.

DOI:10.1093/bjsopen/zrae059

PMID:38814751

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11138960/

Abstract

BACKGROUND

Postoperative pancreatic fistulas remain a driver of major complications after partial pancreatectomy. It is unclear whether coverage of the anastomosis or pancreatic remnant can reduce the incidence of postoperative pancreatic fistulas. The aim of this study was to evaluate the effect of autologous or artificial coverage of the pancreatic remnant or anastomosis on outcomes after partial pancreatectomy.

METHODS

A systematic literature search was performed using MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL) up to March 2024. All RCTs analysing a coverage method in patients undergoing partial pancreatoduodenectomy or distal pancreatectomy were included. The primary outcome was postoperative pancreatic fistula development. Subgroup analyses for pancreatoduodenectomy or distal pancreatectomy and artificial or autologous coverage were conducted.

RESULTS

A total of 18 RCTs with 2326 patients were included. In the overall analysis, coverage decreased the incidence of postoperative pancreatic fistulas by 29% (OR 0.71, 95% c.i. 0.54 to 0.93, P < 0.01). This decrease was also seen in the 12 RCTs covering the remnant after distal pancreatectomy (OR 0.69, 95% c.i. 0.51 to 0.94, P < 0.02) and the 4 RCTs applying autologous coverage after pancreatoduodenectomy and distal pancreatectomy (OR 0.53, 95% c.i. 0.29 to 0.96, P < 0.04). Other subgroup analyses (artificial coverage or pancreatoduodenectomy) showed no statistically significant differences. The secondary endpoints of mortality, reoperations, and re-interventions were each affected positively by the use of coverage techniques. The certainty of evidence was very low to moderate.

CONCLUSION

The implementation of coverage, whether artificial or autologous, is beneficial after partial pancreatectomy, especially in patients undergoing distal pancreatectomy with autologous coverage.

摘要

背景

胰部分切除术后胰瘘仍然是主要并发症的驱动因素。尚不清楚吻合口或胰腺残端的覆盖是否可以降低术后胰瘘的发生率。本研究旨在评估胰部分切除术后胰腺残端或吻合口自体或人工覆盖对结局的影响。

方法

使用 MEDLINE 和 Cochrane 对照试验中心注册库（CENTRAL）进行系统文献检索，检索时间截至 2024 年 3 月。所有分析胰部分胰十二指肠切除术或胰远端切除术患者覆盖方法的 RCT 均被纳入。主要结局是术后胰瘘的发生。进行了胰十二指肠切除术或胰远端切除术以及人工或自体覆盖的亚组分析。

结果

共纳入 18 项 RCT 共计 2326 例患者。总体分析显示，覆盖可使术后胰瘘的发生率降低 29%（OR 0.71，95%CI 0.54 至 0.93，P<0.01）。在胰远端切除术后覆盖残端的 12 项 RCT 中（OR 0.69，95%CI 0.51 至 0.94，P<0.02）和胰十二指肠切除术和胰远端切除术后应用自体覆盖的 4 项 RCT 中（OR 0.53，95%CI 0.29 至 0.96，P<0.04）也观察到了这种降低。其他亚组分析（人工覆盖或胰十二指肠切除术）未显示出统计学差异。使用覆盖技术对死亡率、再次手术和再干预等次要终点都有积极影响。证据的确定性为低到中等。