胰体尾切除术手工缝合与器械闭合断端预防胰瘘效果的Meta分析

Efficacies of hand and stapler suture in preventing pancreatic fistula after distal pancreatectomy： a Meta analysis

目的比较胰体尾切除术采用手工缝合与器械闭合胰腺断端预防胰瘘的效果。方法检索2011年12月以前医学文献检索服务系统和电子数据库，经过筛选，纳入前瞻性对照研究和回顾性研究，提取数据资料进行Meta分析。所纳入研究中胰瘘的诊断标准均采用国际胰腺外科组织胰瘘诊断标准。采用J『2对异质性进行定量分析。采用固定或随机效应模型合并数据。计数资料采用优势比（DR）及95％可信区间（95％CI）表示。结果共纳入10篇比较胰体尾切除术手工缝合与器械闭合断端胰瘘发生率的文献，其中前瞻性随机对照研究1篇，前瞻性非随机对照研究3篇，回顾性研究6篇。10篇文献中手工组患者1441例，器械组患者612例。Meta分析结果显示：手术组与器械组患者术后胰瘘发生率比较，差异无统计学意义（OR=1．10，95％CI：0．86～1．40，P〉0．05）。其中6篇文献比较了手工缝合与器械闭合严重胰瘘（B、C级胰瘘）发生率，手工组患者1182例，器械组患者383例。Meta分析结果显示：手术组与器械组患者术后严重胰瘘发生率比较，差异无统计学意义（OR=1．33，95％CI：0．94～1．88，P〉0．05）。结论胰体尾切除术采用手工缝合与器械闭合胰腺断端预防胰瘘的效果相当，器械闭合只是为胰体尾切除术中胰腺断端的处理方式提供了另一选择。

Objective To compare the incidence of pancreatic fistula after hand and stapler suture in preventing pancreatic fistula after distal pancreateetomy. Methods The literatures published before December 2011 were retrieved from SinoMed and electronic database. Prospective controlled trials and retrospective reports were screened out for Meta analysis. The diagnostic criteria of pancreatic fistula were based on the criteria formulated by the International Study group of Pancreatic Fistula. The heterogeneity of the studies was analyzed using the I2 test. The data were integrated using the fixed or random effect model. The results of the Meta analysis were pre- sented with odds ratio （OR） and 95% confidence interval （95% CI）. Results According to the selection criteria, 10 literatures were selected which included 1 prospective randomized controlled study, 3 prospective non- randomized controlled studies and 6 retrospective studies. There were 1 441 cases in the hand suture group and 612 cases in the stapler suture group. There was no significant difference in the incidences of the pancreatic fistula between the hand suture group and the stapler suture group （ OR = 1.10, 95% CI： O. 86-1.40, P 〉 0.05 ）. Six studies compared the incidences of severe pancreatic fistula （ grade B or C） between the hand suture group and the stapler suture group. There were 1 182 cases in the hand suture group and 383 cases in the stapler suture group. There was no significant difference in the incidence of severe pancreatic fistula between the hand suture group and the stapler suture group （OR=1.33, 95%CI： 0.94-1.88, P〉0.05）. Conclusion The efficacies of hand suture and stapler suture in preventing pancreatic fistula after distal pancreatectomy are comparable. Stapler suture provides an another option in distal panereatectomy.