胰肠吻合方式与胰十二指肠切除术后并发症相关性的meta分析

A Meta-Analysis of Pancreaticojejunostomy on Postoperative Outcomes Following Pancreaticoduodenectomy

目的系统评价胰十二指肠切除术中采用胰管对黏膜胰肠吻合(dmPJ)和套入式胰肠吻合(iPJ)对术后并发症的影响。方法在Pubmed、The Cochrane Library、Embase、万方数据库及中国期刊全文数据库中检索所有比较胰十二指肠切除术中采用不同胰肠吻合方式的前瞻性随机对照试验(RCT)。按照拟定的纳入标准与排除标准对文献进行筛选;文献质量评价参考Jadad质量评分系统;meta分析运用Rev Man 5.2版。结果共纳入9篇RCT,患者1 032例,其中dm PJ组510例,i PJ组522例。meta分析结果显示:dm PJ组和i PJ组的总胰瘘发生率(OR=0.95,P=0.78)、临床相关胰瘘发生率(OR=0.78,P=0.71)、总并发症发生率(OR=0.93,P=0.60)、围手术期死亡率(OR=0.86,P=0.71)、再手术率(OR=1.18,P=0.59)及住院时间(WMD=-1.11,P=0.19)的差异均无统计学意义。结论胰十二指肠切除术中采用dm PJ或i PJ对术后胰瘘及其他并发症发生率的影响无明显差异。

Objective To evaluate the effects of duct-to-mucosa pancreaticojejunostomy （dmPJ） and invagination pancreaticojejunostomy （iPJ） during pancreaticoduodenectomy （PD） on postoperative outcomes. Methods Pubmed, The Cochrane Library, Embase, Wanfang and CNKI database were searched to identify randomized controlled trials （RCTs） evaluating different type of pancreaticojejunostomy during PD. The literatures were screened according to inclusion and exclusion criteria. Quality assessment was conducted according to Jadad scoring system. Results Nine RCTs were included, 1 032 patients were recruited, including 510 patients in dmPJ group and 522 patients in iPJ group. Meta-analysis indicated that there were no significant differences between two groups in terms of the incidence of pancreatic fistula in total （OR=0.95, P=0.78）, clinical relevant pancreatic fistula （OR=0.78, P=0.71）, overall morbidity （OR=0.93, P=0.60）, perioperative mortality （OR=0.86, P=0.71）, reoperation rate （OR= 1.18, P=0.59）, and length of hospital stay （WMD=- 1.11, P=0.19）. Conclusion DmPJ and iPJ are comparable in terms of pancreatic fistula and other complications.