胰体尾切除术术后常规腹腔引流与不引流的Meta分析：现有最佳证据能否克服“肝脏胰腺胆管外科医生的偏执”？
Meta-analysis of routine abdominal drainage versus no drainage following distal pancreatectomy: Does the best available evidence overcome "HPB surgeon's paranoia"?
作者信息
Hajibandeh Shahin, Mostafa Omar Es, Akula Yeswanth, Ghassemi Nader, Hajibandeh Shahab, Bhatt Anand, Durkin Damien, Athwal Tejinderjit S, Laing Richard W
机构信息
Department of Hepatobiliary and Pancreatic Surgery, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK.
Department of Surgery, Russells Hall Hospital, Dudley Group NHS Trust, Dudley, UK.
出版信息
Pancreatology. 2024 Dec;24(8):1360-1372. doi: 10.1016/j.pan.2024.11.012. Epub 2024 Nov 20.
AIMS
To evaluate comparative outcomes of routine abdominal drainage versus no drainage after distal pancreatectomy (DP).
METHODS
A systematic search of MEDLINE, CENTRAL and Web of Science and bibliographic reference lists were conducted (last search: 20th April 2024). All comparative studies reporting outcomes of DP with routine abdominal drainage and no drainage were included and their risk of bias were assessed. Overall perioperative complications, clinically-relevant postoperative pancreatic fistula (CR-POPF), delayed gastric emptying (DGE), postoperative haemorrhage, surgical site infections (SSIs), need for radiological intervention, reoperation, re-admission, and postoperative mortality were the evaluated outcome parameters.
RESULTS
Eight comparative studies (2 randomised and 6 observational) reporting 8164 patients who underwent DP with (n = 6394) or without (n = 1770) routine abdominal drainage were included. Routine abdominal drainage was associated with significantly higher rates of CR-POPF (OR 2.87; 95 % CI 2.34-3.52, p < 0.00001), radiological intervention (OR 1.33; 95 % CI 1.10-1.61, p = 0.0003), SSIs (OR 2.47; 95 % CI 1.29-4.72, p = 0.006) or re-admission (OR 1.54; 95 % CI 1.30-1.82, P < 0.00001) compared to no use of drain. However, there was no significant difference in C-D III or higher postoperative morbidities (OR 1.25; 95 % CI 0.98-1.60, p = 0.08), DGE (OR 1.17; 95 % CI 0.81-1.67, p = 0.41), reoperation (OR 1.11; 95 % CI 0.80-1.54, P = 0.53), postoperative haemorrhage (OR 0.59; 95 % CI 0.18-2.00, P = 0.40), or mortality (RD 0.0; 95 % CI -0.01-0.01, p = 0.76) between two groups.
CONCLUSIONS
The meta-analysis of best available evidence indicates safety of "no drain policy" in distal pancreatectomy considering its lower risk of CR-POPF, re-intervention and hospital re-admission. More randomised evidence is required to overcome the "HPB surgeon's paranoia".
目的
评估远端胰腺切除术（DP）后常规腹腔引流与不引流的对比结果。
方法
对MEDLINE、CENTRAL和科学网进行系统检索，并查阅参考文献列表（最后一次检索时间：2024年4月20日）。纳入所有报告DP常规腹腔引流与不引流结果的对比研究，并评估其偏倚风险。评估的结局参数包括围手术期总体并发症、临床相关术后胰瘘（CR-POPF）、胃排空延迟（DGE）、术后出血、手术部位感染（SSI）、放射介入需求、再次手术、再次入院和术后死亡率。
结果
纳入八项对比研究（两项随机对照研究和六项观察性研究），共8164例接受DP的患者，其中6394例行常规腹腔引流，1770例未行常规腹腔引流。与不使用引流相比，常规腹腔引流与CR-POPF发生率显著更高（OR 2.87；95%CI 2.34 - 3.52，p < 0.00001）、放射介入（OR 1.33；95%CI 1.10 - 1.61，p = 0.0003）、SSI（OR 2.47；95%CI 1.29 - 4.72）或再次入院（OR 1.54；95%CI 1.30 - 1.82，P < 0.00001）相关。然而，两组在C-D III级或更高等级的术后并发症（OR 1.25；95%CI 0.98 - 1.60，p = 0.08）、DGE（OR 1.17；95%CI 0.81 - 1.67，p = 0.41）、再次手术（OR 1.11；95%CI 0.80 - 1.54，P = 0.53）、术后出血（OR
Zotero 插件