胰十二指肠切除术后导管对黏膜与套入式胰肠吻合的Meta分析

Duct-to-mucosa versus invagination pancreaticojejunostomy after pancreaticoduodenectomy:a meta-analysis

目的评价胰腺空肠导管对黏膜吻合和套入式胰肠吻合对胰十二指肠切除术后并发症的影响。方法计算机检索Cochranelibrary、Pubmed、OVID、SpringerLinker、ScienceDirect、EBSCO、中国知网、维普医药信息资源系统、万方数据医药系统等中外生物医学数据库，并结合文献追溯的方式，检索2016年1月以前有关导管对黏膜与套入式胰肠吻合在胰十二指肠切除术后临床疗效的前瞻性随机对照试验。按Cochrane系统评价方法，评价所纳入研究的文献质量，并提取有效数据后采用ReviewManager5．3软件进行Meta分析。结果共纳入6篇随机对照研究文献，计有706例患者，其中导管对黏膜吻合组349例，套入式胰肠吻合组357例。Meta分析结果显示：两种胰肠吻合方式在胰瘘发生率（OR=1．24，95％C1：0．81—1．90，P=0．33）、胃排空障碍发生率（OR=0．84，95％CI：0．40～1．73，P=0．84）、围手术期死亡率（OR=0．91，95％CI：0．38～2．20，P=0．84）、并发症发生率（OR=0．97，95％CI：0．72—1．31，P=0．83）、再手术率（OR=1．40，95％CI：0．74—2．65，P=0．30）、住院时间（WMD=-1．19，95％C1：-3．49～1．12，P=0．31）、Claveinm级及以上并发症发生率（OR=1．12，95％CI：0．67～1．88，P=0．66）、软胰的胰瘘发生率（OR=1．53，95％CI：0．81—2．89，P=0．19）及B、C级胰瘘发生率（OR=1．26，95％CI：0．69—2．31，P=0．45）等方面的差异均无统计学意义。结论胰十二指肠切除术后导管对黏膜与套人式胰肠吻合对术后胰瘘发生率、围手术期死亡率、并发症发生率、再手术率、住院时间、Claveinm级及以上并发症发生率、软胰的胰瘘发生率及B、C级胰瘘发生率等的影响无差异。

Objective To evaluate the pancreatic fistula affected by different type of pancreaticojejunostomy after pancreati- coduodenectomy. Methods A search of Cochrane library, Pubmed, OVID, Springer Linker, Science Direct, EBSCO, CNKI, VIP and Wanfang database was undertaken and studies published before July 2015 were identified. We included randomized controlled trials that compared duct-to-mncosa versus invagination pancreaticojejunostomy after pancreaticoduodenectomy in our Meta-analysis. Studies selection and Meta-analysis were performed using Review-Manager 5.3 software according to the Cochrane Handbook. Results Five RCTs （706 patients; duct-to-mucosa： 349; invagination： 357） were included. Pancreatic fistula rate（ OR = 1.24,95% CI：0. 81 - 1.90, P = 0. 33 ）, delayed gastric emptying（ OR = 0. 84,95 % CI： 0. 40 - 1.73, P = 0. 84 ）, mortality （ OR = 0. 91,95 % CI：0. 38 - 2. 20, P =0. 84）, morbidity（ OR =0.97,95% CI：0. 72 - 1.31 ,P =0. 83）, reoperation（ OR = 1.40,95% CI：O. 74 -2. 65 ,P =0. 30）, hospi- tal stay（ WMD = - 1.19,95% CI： - 3.49 - 1.12 ,P = 0. 31 ）, major morbidity（ OR = 1.12,95% CI：0. 67 - 1.88, P = 0. 66 ）, fistula in soft pancreatic（ OR = 1.53,95% CI：0. 81 -2. 89 ,P =0. 19） and clinical relevant pancreatic fistula（ OR = 1.26,95% CI：0. 69 - 2. 31, P = 0. 45 ） were similar between duct-to-mucosa group and invagination group. Conclusion No evidence suggests significant differ- ences in pancreatic fistula rate, mortality, morbidity, reoperation, hospital stay, major morbidity, fistula in soft pancreatic and clinical relevant pancreatic fistula between the two techniques. Our conclusions were limited by the available data. Further evaluations of high -quality RCTs are needed.