胰十二指肠切除术后两种胰肠吻合方式的安全性评价

Evaluation of the safety of two types of pancreatojejunostomy after pancreaficoduodenectomy

目的评价胰十二指肠切除术后胰管空肠黏膜吻合与胰肠套入式吻合的安全性。方法检索CSCD、PubMed、The Cochrane Library、Web of Science以及EMBASE等数据库中发表的关于胰十二指肠切除术后胰管空肠黏膜吻合与胰肠套入式吻合的临床随机对照试验。研究指标包括术后胰瘘、病死率、总并发症、胃排空延迟、腹腔积液、术后出血、再次手术率，采用RevMan5．3软件进行Meta分析。结果8篇文献、1194例被纳入本研究。Meta分析结果：胰管空肠黏膜吻合与胰肠套入式吻合术后总胰瘘率（OR=1．31，95％CI：0．95—1．79，P=0．10）、质地较软胰腺术后胰瘘率（OR=1．64，95％CI：0．77～3．48，P=0．20）、病死率（OR=1．02，95％CI：0．46—2．26，P=0．97）、术后出血（OR=1．13，95％CI：0．47—2．71，P=0．78）差异无统计学意义。此外，在总并发症、胃排空延迟、腹腔积液、再次手术率方面差异也无统计学意义。结论两种重建方式的安全性相当，对质地较软的胰腺而言，套入式胰肠吻合并未显示出明显优势．因此术者应根据对患者综合评估的结果选择合适的重建方式。

Objective To evaluate the safety of duct-to-mucosa and invaginating pancreaticojejunostomy after pancreaticoduodenectomy. Methods Randomized controlled trials comparing duct-to-mucosa with invagination pancreaticojejunostomy following PD were searched, through Datebases CSCD, PubMed, The Cochrane Library, Web of Science and EMBASE, Outcome measures included postoperative pancreatic fistula, mortality, intra-abdominal collection, delayed gastric emptying, overall morbidity, postoperative hemorrhage and reoperation, the statistical analysis was done by RevManS. 3 soft ware. Results A total of 8 trials, 1 194 patients, were included in this Meta-analysis, No statistical difference were found in postoperative pancreatic fistula （ OR = 1.31,95% CI： 0. 95 - 1.79, P = 0. l0 ）, Pancreatic fistula with soft texture of the pancreas （ OR = 1.64,95% CI：0. 77 - 3.48, P = 0. 20）, mortality （ OR = 1.02,95% CI：0. 46 - 2. 26, P = 0. 97） and postoperative hemorrhage （ OR = 1.13,95% CI：0. 47 - 2. 71, P = 0. 78） between duct-to-mucosa and invaginating pancreatojejunostomy. There were nor significant differences in overall morbidity, intra-abdominal collection, delayed gastric emptying and reoperation between the two groups. Conclusions The Meta-analysis based on 8 randomized controlled trials shows that the safety of the two reconstruction techniques is comparable. For soft texture of the pancreas, invaginated pancreatojejunostomy did not show a statistically significant superiority. Therefore, the surgeon should choose a reasonable reconstruction technique according to the results of the comprehensive evaluation of the patients.