胰十二指肠切除术后胰漏相关危险因素的Meta分析

Meta-analysis of risk factors for pancreatic fistula after pancreatoduodenectomy in China

目的分析我国胰十二指肠切除术(PD)后发生胰漏的危险因素,为临床有效降低胰漏的发生提供理论支持。方法采用Meta分析的方法,对我国2002年6月—2012年6月期间公开发表的有关PD术后发生胰漏的危险因素的33篇文献进行分析。结果年龄、性别、术前白蛋白、血红蛋白、手术时间及有无合并糖尿病、高血压、冠心病对PD术后胰漏的发生无相关性(P>0.05);术前胆红素水平≥171μmol/L组胰漏发生率明显高于胆红素水平<171μmol/L组(P<0.05),而术前进行减黄治疗无明显降低胰漏的发生(P>0.05);胰管直径≥3 mm组胰漏发生率明显低于胰管直径<3 mm组(P<0.05);放置胰管支撑物引流组能明显降低胰漏的发生(P<0.05);术中出血量≥1 L组胰漏发生率明显高于出血量<1 L组(P<0.05);术后使用生长抑素类药物组能有效降低胰漏的发生率(P<0.05);既往有上腹部手术史组PD术后胰漏发生率明显高于既往无上腹部手术史组(P<0.05)。结论术前高胆红素血症、胰管直径细小、未放置胰管支撑物引流、术中出血量较多、术后未预防性使用生长抑素类药物及既往有上腹部手术史是胰漏的危险因素。

Objective To explore the risk factors of pancreatic fistula after pancreatoduodenectomy（ PD） in China,and provide a theoretical basis for reducing the incidence of postoperative pancreatic fistula. Methods Meta-analysis was used in 33 papers on risk factors of the pancreatic fistula after pancreaticoduodenectomy published in China from June2002 to June 2012. Results There were no positive correlation between the incidence of pancreatic fistula after PD and the age and gender of patients,preoperative levels of albumin and hemoglobin,operation time,and the combination with diabetes,hypertension and coronary heart disease（ P〉0. 05）. The patient with high level of preoperative jaundice（ higher than 171 μmol / L） were with higher incidence of pancreatic fistula after PD when compared with the patients with a preoperative jaundice level of less than 171 μmol / L（ P〈0. 05）,furthermore,the preoperative biliary drainage therapy might not decrease the incidence of pancreatic fistula after PD（ P〉0. 05）. The patients with pancreatic duct diameter greater than 3mm had lower incidence of pancreatic fistula than those with duct diameter less than 3 mm（ P〈0. 05）. The pancreatic duct drainage with stent decreased the incidence of pancreatic fistula after PD（ P〈0. 05）. The patients with the amount of bleeding during the operation more than 1 000 ml had a higher incidence of pancreatic fistula after PD（ P〈0. 05）. The postoperative somatostatin administration might decrease the incidence of pancreatic fistula after PD（ P〈0. 05）. The patients with a history of abdominal surgery had a higher rate of pancreatic leak than the control group after PD（ P〈0. 05）. Conclusion The pancreatic fistula after PD does not positively correlated with gender and age of patients,preoperative levels of albumin and hemoglobin,operation time,and the combination with diabetes,hypertension and coronary heart disease. The preoperative severe jaundice,small pancreatic duct diameter,without the support of the pancreatic duct drainage,the amount of bleeding,unused somatostatin and operation on abdominal region are the risk factors of the pathogenesis of pancreatic fistula.