胰十二指肠切除术后胰瘘危险因素的Meta分析

Meta-analysis of risk factors of pancreatic fistula after pancreaficoduodenectomy

目的探讨胰十二指肠切除术后胰瘘的危险因素,为降低术后胰瘘发生率提供理论依据。方法使用RevMan 5.2对1997年3月至2017年3月期间在国内外发表的关于胰十二指肠切除术后胰瘘的危险因素分析的13篇临床研究论著进行Meta分析。结果年龄、性别、糖尿病、高血压、疾病良恶性、手术时间、术中出血量、幽门是否保留、胰肠吻合方式、胰管内是否放置支撑管以及术后是否使用生长抑素在术后胰瘘发生率上差异无统计学意义(P>0.05);术后胰瘘的危险因素分别为:术前总胆红素≥171μmol/L[OR=0.76;95%CI:(0.59,0.98);P<0.05];术前白蛋白<35 g/L[OR=1.69;95%CI:(1.02,2.81);P<0.05];胰腺质地柔软[OR=0.34;95%CI:(0.23,0.50);P<0.05];胰管直径<3 mm[OR=2.73;95%CI:(1.92,3.89);P<0.05]。结论术前高胆红素、术前低蛋白血症、胰腺质地柔软以及胰管细小会使术后胰瘘发生率升高,而年龄、性别、糖尿病、高血压、疾病良恶性、手术时间、术中出血量、幽门是否保留、胰肠吻合方式、胰管内是否放置支撑管以及术后是否使用生长抑素均未使胰瘘发生率产生显著性变化。但是,胰肠吻合方式采用捆绑式还是套入式、胰管内是否放置支撑管以及术后是否使用生长抑素目前仍有争议,需更进一步的探讨。

Objective To explore the risk factors of pancreatic fistula after pancreaticoduodenectomy(PD),and provide theoretical basis for reducing the rate of postoperative pancreatic fistula.Methods Meta analysis was used in 13 articles regarding risk factors of pancreatic fistula after pancreaticoduodenectomy published from March 1997 to March 2017 by the RevMan 5.2 software.Results The age,gender,diabetes,hypertension,benign or malignant diseases,operative time,blood loss,pylorus preservation,pancreaticojejunostomy,placement of a support tube in the pancreatic duct and postoperative use of somatostatin were not statistically significant(P>0.05);But the results show that preoperative bilirubin(OR=0.76,95%CI:0.59,0.98,P<0.05),preoperative albumin(OR=1.69,95%CI:1.02,2.81,P<0.05),soft texture of pancreas(OR=0.34,95%CI:0.23,0.50,P<0.05),diameter of pancreatic duct(OR=2.73,95%CI:1.92,3.89,P<0.05)are factors affecting the risk of pancreatic fistula.Conclusion Preoperative high bilirubin,preoperative hypoproteinemia,soft texture of pancreas and small pancreatic duct may increase the incidence of postoperative pancreatic fistula,while age,gender,diabetes,hypertension,benign and malignant diseases,operation time,intraoperative blood loss,pylorus preservation,pancreaticojejunostomy,whether to place a supporting tube in the pancreatic duct and whether to use somatostatin after operation did not produce significant changes in the incidence of pancreatic fistula.However,it is still controversial whether the pancreaticojejunostomy is bundled or nested,whether to place a support tube in the pancreatic duct,and whether to use somatostatin after surgery.