胰十二指肠切除术后胰瘘危险因素的荟萃分析

Risk factors of pancreatic fistula after pancreaticoduodenectomy: a meta-analysis

目的运用荟萃分析评估胰十二指肠切除术后胰瘘的相关危险因素，以指导临床诊治。方法使用RevMan5．2对2005年1月至2014年9月间国内发表的关于胰十二指肠切除术后胰瘘的危险因素分析的12篇文献进行Meta分析。结果性别、年龄、糖尿病、冠心病、高血压、手术时间、术前总胆红素以及术后是否使用生长抑素与术后胰瘘的发生无统计学意义（P〉0．05）；而术前白蛋白低于30g／L（OR：0．52，95％CI：0．33—0．80，P〈0．01）、胰腺质地柔软（OR=0．20，95％CI：0．14—0．29，P〈0．01）、胰管直径小于3Mm（OR=0．26，95％CI：0．17—0．42，P〈0．01）、胰管未放置支撑管（OR=0．52，95％CI：0．31～0．88，P〈0．05）以及胰肠套人式吻合（OR=0．60，95％CI：0．38—0．95，P〈0．05）与术后胰瘘的发生关系密切。结论胰十二指肠切除术后胰瘘与患者性别、年龄、糖尿病、冠心病、高血压、手术时间、术前总胆红素以及术后是否使用生长抑素；而术前低蛋白血症、质软的胰腺质地、细小的胰管、胰管支撑管是否放置以及胰肠吻合方式的选择等因素影响着术后胰瘘的发生。

Objective To investigate the risk factors of pancreatic fistula after pancreaticoduodenectomy by using systemic method. Methods Meta analysis was used in 12 articles about risk factors of pancreatic fistula after pancreaticoduodenectomy published from January 2005 to September 2014. Results The gender, age, comorbidities like MD, coronary disease and hypertension had no significance differences with the incidence of pancreatic fistula. But the results showed that preoperative albumin（ OR = 0. 52, 95 % CI：0. 33 - 0. 80, P 〈 0. 01 ）, pancreatic texture （ OR = 0. 20,95 % CI： 0. 14 - 0. 29, P 〈 0. 01 ）, diameter of pancreatic duct （ OR = 0. 26,95 % CI：0. 17 - 0. 42, P 〈 0. 01 ）, stent in pancreatic duct （ OR = 0. 52,95 % CI： 0. 31 -0. 88, P 〈 0. 05 ） and the method of pancreaticojejunostomy （OR=0.60,95% CI：0.38 -0.95,P 〈0.05）were risk factors of pancreatic fistula. Conclusion the incidence of pancreatic fistula had relationship with preoperative hypo-albumin, soft pancreatic texture, small pancreatic duct, stent in major pancreatic duct and invaginative pancreaticojejunostomy.