奥曲肽预防胰腺切除术后胰瘘及相关并发症的Meta分析

Prophylactic octreotide in the prevention of pancreatic fistula and its related complications after pancreatic resection： a Meta-analysis

目的应用循证医学方法系统评价胰腺切除术后患者使用奥曲肽预防胰瘘及相关并发症的疗效。方法通过计算机检索Pubmed、Embase、Cochrane等数据库及相关参考文献，纳入1990年1月至2017年6月有关胰腺切除术后应用奥曲肽预防胰瘘效果的前瞻性随机对照研究进行分析。根据Cochrane系统评价纳入文献质量，提取有效数据。使用Review Manager5．3软件完成Meta分析。结果最终纳入13篇随机对照研究、2108例患者。其中奥曲肽组1057例，对照组1051例。Meta分析结果显示，与对照组相比，术后应用奥曲肽组患者总体胰瘘（A、B、C级胰瘘）及总体并发症发生率降低，差异有统计学意义（分别为14．7％比21．6％，RR=0．67，95％CI：0．56—0．81，P〈0．05；25．7％比35．7％，RR=0．71，95％CI：0．58—0．87，P〈0．05）。但是奥曲肽组与对照组在临床相关性胰瘘（B、C级胰瘘）发生率、围手术期病死率、胃排空延迟、出血、腹腔内感染、术后胰腺炎等其他并发症发生率和再手术率方面差异均无统计学意义（均P〉0．05）。结论胰腺切除术后预防性使用奥曲肽可有效降低术后总体胰瘘发生率，可在一定程度上减少术后总体并发症的发生，但是无法减少临床相关性胰瘘（B、C级胰瘘）的发生，不能使患者围手术期病死率降低。

Objective To study the clinical impact of prophylactic octreotide on patients who underwent pancreatic resection using evidence-based medicine. Methods Electronic databases which included the Cochrane library, Pubmed and Embase were searched. A Meta-analysis of all randomized controlled trials （RCTs） on the clinical impact of prophylactic octreotide on pancreatic resection was performed. The evaluation of the literature quality and the effective of the data were based on the Cochrane Handbook for systematic reviews. The Review Manager 5.3 was used for the meta-analysis. Results 13 studies which involved 2 108 patients were included into this study, with 1 057 patients in the octreotide group and 1 051 patients in the control group. Meta-analysis revealed that the rates of pancreatic fistula （PF）, including Class A, B and C and the total postoperative complication rate were lower in patients treated with prophylactic octreotide than those without octreotide （ 14.7% vs. 21.6%, RR = 0. 67, 95% CI： 0. 56 - 0. 81, P 〈 0. 05 ; 25.7% vs. 35.7%, RR = 0.71, 95% CI： 0. 58 - 0. 87, P 〈 0.05 ）. However, octreotide did not significantly reduce the incidences of clinically relevant fistulas including Class B and C, perioperative mortality, delayed gastric emptying, bleeding, abdominal infection, postoperative pancreatitis, and re-operation （ all P 〉 0. 05）. Conclusion Octreotide reduced PF including Class A, B and C and decreased the total complication rate, but did not reduce the clinically relevant fistulas and perioperative mortality.