手工缝合与闭合器闭合预防胰体尾切除术后胰瘘疗效Meta分析

Comparison of efficacy between manual suture and stapler suture in preventing pancreatic fistula after distal pancreatectomy:a Meta analysis

目的系统评价手工缝合和闭合器闭合两种胰腺残端处理方式对胰体尾切除术后胰瘘的预防效果。方法通过计算机检索中国知网、万方、维普、中国生物医学文献数据库、PubMed、Web of Science、Embase和Cochrane Library数据库,搜索建库至2020年2月29日我国手工缝合和闭合器闭合两种胰腺残端处理方式对胰体尾切除术后胰瘘预防效果的病例对照研究和队列研究。中文检索词主要包括:胰体尾切除术、胰腺远端切除术、胰瘘、手工缝合、闭合器;英文检索词主要包括:distal pancreatectomy、pancreatic fistula、suture、stapler。对纳入文献提取手工缝合组和闭合器闭合组术后胰瘘发生率等数据进行Meta分析。结果共纳入13篇研究,1 198例患者;其中手工缝合组652例,闭合器闭合组546例。Meta分析结果显示,手工缝合组与闭合器闭合组患者术后胰瘘发生率比较差异无统计学意义(OR=1.13,95%CI:0.66~1.94;P>0.05),但闭合器闭合组术后临床性胰瘘发生率明显降低(OR=1.48,95%CI:1.00~2.18;P<0.05)。结论相较手工缝合,胰体尾切除术后行闭合器闭合胰腺残端有利于降低术后临床性胰瘘发生率。

Objective To systematically evaluate the preventive effect between manual suture and stapler suture on pancreatic fistula after distal pancreatectomy.Methods Case-control and cohort studies about the preventive effect of manual suture and stapler suture for pancreatic fistula after distal pancreatectomy in China were searched in the databases of CNKI,Wanfang data,VIP,CBM,PubMed,Web of Science,Embase and Cochrane Library from the database establishment until February 29th,2020.The Chinese and English keywords mainly included distal pancreatectomy,pancreatic fistula,suture and stapler.Meta-analysis was conducted with data of pancreatic fistula incidence and other data in two groups.ResultsA total of 13 studies including 1 198 patients were included.Among them,there were 652 cases in the manual suture group,and 546 cases in the stapler suture group.Meta-analysis showed that the incidence of pancreatic fistula did not significantly differ between the manual and stapler suture groups (OR=1.13,95%CI:0.66-1.94;P>0.05).However,the incidence of clinical pancreatic fistula in the stapler suture group was significantly decreased (OR=1.48,95%CI:1.00-2.18;P<0.05).Conclusions Compared with the manual suture,stapler suture can lower the incidence of clinical pancreatic fistula after distal pancreatectomy.