胰十二指肠切除术应用胰管支撑管的Meta分析

Clinical value of transanastomotic pancreatic ductal stents placement after pancreaticoduodenectomy：a meta analysis

目的系统评价胰十二指肠切除术应用胰管支撑管的临床疗效。方法检索中英文数据库，根据Cochranereviewers手册5．0筛选文献、提取资料、评价文献质量。使用RevMan5．0．18软件进行Meta分析。采用随机效应模型合并数据，计数资料采用优势比（OR）及95％可信区间（95％C1）表示。结果本研究纳入4篇临床随机对照试验研究（RCT），纳入患者557例，其中放置支撑管外引流160例，内引流115例。Meta分析结果显示：胰管放置与不放置支撑管比较，患者胰瘘发生率、总体并发症发生率和病死率的差异均无统计学意义（OR=0．66，0．70，0．63，P〉0．05）。但放置支撑管外引流与不放置支撑管比较，患者胰瘘发生率和总体并发症发生率的差异有统计学意义（OR=0．48，0．55，P〈0．05）；患者病死率比较，差异无统计学意义（OR=0．71，P〉0．05）。1篇比较支撑管内引流与不放置支撑管疗效的RCT研究结果发现，两种治疗方式患者在胰瘘发生率、总体并发症发生率和病死率等方面比较，差异均无统计学意义（X^2=0，0．75，2．11，P〉0．05）。结论使用支撑管外引流可以减少患者胰十二指肠切除术后胰瘘和总体并发症的发生；支撑管内引流的临床疗效尚需RCT进一步证实。

Objective To systematically review the clinical efficacy of transanastomotic pancreatic ductal stents placement after pancreaticoduodenectomy. Methods According to the Coehrane reviewers handbook （version 5. 0 ）, literatures were retrived from PubMed, Embase, Cochrane, VIP database, China Biology Medicine disc and CNKI database, and then the quality of the literatures was analyzed. Meta analysis was carried out using the RevMan software （version 5.0.18）. A random effects model was adopted, and the results of the meta analysis were presented with odds ratio （ OR ） and 95% confidence interval （95% CI）. Results Four randomized controlled trials including 557 patients were retrieved. External stents were used in 160 patients and internal stents in 115 patients. The results of meta analysis showed no significant difference in the rate of fistula, overall postoperative morbidity and mortality between patients who did or did not receive pancreatic stents placement （OR =0. 66, 0. 70, 0. 63, P 〉 0.05）. There were significant differences in the rate of pancreatic fistula and overall postoperative morbidity between patients who received external pancreatic stents placement and those did not receive pancreatic stents placement （ OR = 0. 48, 0. 55, P 〈 0.05）. There was no significant difference in the mortality rate between patients who received external pancreatic stents placement and those did not receive pancreatic stents placement （ OR = 0. 71, P 〉 0.05 ）. There were no significant difference in the incidence of pancreatic fistula, overall postoperative morbility and mortality between patients who reeeived internal pancreatic stents placement and those did not receive pancreatic stents placement （ X^2 = 0, 0. 75, 2.11, P 〉 0. 05 ）. Conclusions External pancreatic stents placement after pancreatieoduodeneetomy can reduce the incidence of postoperative complications. The effects of internal pancreatic stents placement need to be proved by further high-quality prospective randomized trials.