胰管支撑外引流与非引流在胰十二指肠切除术后疗效对比的Meta分析

Efficacy comparison between external drainage of pancreatic duct with a stent and non-drainage after pancreaticoduodenectomy: a Meta-analysis

目的:评估胰管外引流在胰十二指肠切除术(PD)后的应用临床效果。方法:检索PubMed、Cochrane Library、EMBASE、Web of Science等相关数据库,纳入2000年1月—2017年12月的有关在PD术中比较胰管支撑外引流与非引流的研究,对每个试验进行评估并且提取数据后行Meta分析。结果:共纳入4项随机对照试验(RCT),共458例患者,其中227例为胰管支撑外引流组,231例为非引流组。Meta分析结果显示,胰管支撑外引流组较非引流组总体胰瘘发生率明显降低(RR=0.57,95%CI=0.40～0.82,P=0.002),且主要降低B/C级胰瘘的发生率(RR=0.57,95%CI=0.38～0.85,P=0.006)以及主要对胰管直径≤3 mm的患者有效(RR=0.55,95%CI=0.37～0.82,P=0.003),此外,在行导管黏膜吻合术患者中,胰管支撑外引流组的胰瘘发生率也较非引流组明显降低(RR=0.42,95%CI=0.22～0.80,P=0.008)。胰管支撑外引流组术后总体并发症较非引流组明显降低(RR=0.79,95%CI=0.64～0.98,P=0.03)。两组患者在胃排空延迟、腹腔出血、腹腔积液、伤口感染与总体术后病死率等方面均无统计学差异(均P>0.05)。结论:胰管支撑外引流的使用能有效减少PD术后胰瘘及术后总体并发症的发生,但该结论仍需大样本、高质量的RCT研究进一步验证。

Objective： To evaluate the clinical efficacy of using external drainage of the pancreatic duct with a stent after pancreaticoduodenectomy （PD）. Methods： The studies comparing the external drainage of pancreatic duct with a stent and non-drainage after PD from January 2000 to December 2017 were collected by searching the relevant databases such as PubMed, EMBASE, the Cochrane Library and Web of Science. After assessment and data extraction of the selected studies, Meta-analysis was performed. Results： Four randomized controlled trials （RCTs） were finally included, involving 458 patients with 227 cases in external drainage group and 231 cases in non-drainage group. The results of Meta-analysis showed that the overall incidence of pancreatic fistula was significantly reduced in external drainage group compared with nondrainage group （RR=0.57, 95% CI=0.40-0.82, P=0.002）, which was mainly contributed by reducing the grade B and C pancreatic fistula （RR=0.57, 95% CI=0.38-0.85, P=0.006） and exerting effect in patients with pancreatic duct diameter ≤3.0 mm （RR=0.55, 95% CI=0.37-0.82, P=0.003）. In addition, the incidence of pancreatic fistula was also significantly reduced in external drainage group compared with non-drainage group among patients undergoing duct-to-mncosa anastomosis （RR=0.42, 95% CI=0.22-0.80, P=0.008）. Moreover, the overall incidence of postoperative complications was significantly decreased in external drainage group compared with non-drainage group （RR=0.79, 95% CI=0.64-0.98, P=0.03）. There were no significant differences in incidence of delayed gastric emptying, abdominal bleeding, intra-abdominal fluid collections, and wound infection as well as the overall postoperative mortality （all P〉0.05）. Conclusion： Using external drainage of the pancreatic duct with a stent after PD can effectively reduce the incidence of pancreatic fistula and postoperative complications. However, this conclusion still needs to be further verified by large sample and high quality RCTs.