大网膜包裹胰肠吻合口预防胰十二指肠切除术后并发症有效性和安全性的Meta分析

Efficacy and safety of omental wrapping technique for pancreaticojejunal anastomosis in preventing complications after pancreaticoduodenectomy:A Meta-analysis

目的系统评价大网膜包裹胰肠吻合口预防胰十二指肠切除术后并发症的有效性和安全性。方法本研究根据PRISMA指南完成。计算机检索中国知网、万方、维普、中国生物医学文献数据库、Cochrane Library、Pub Med、Embase和Web of Science等中英文数据库,从数据库建立至2022年11月有关大网膜包裹胰肠吻合口预防胰十二指肠切除术后并发症的临床研究,采用Stata 16和Review Manager 5.4进行Meta分析。结果纳入15项研究,共1830例患者。Meta分析结果显示:网膜包裹组术后胰瘘总体发生率较非网膜包裹组更低(OR=0.30,95%CI:0.22~0.41,P<0.001),亚组分析提示网膜包裹组B/C级术后胰瘘发生率较非网膜包裹组更低(OR=0.29,95%CI:0.21~0.39,P<0.001)。网膜包裹组相较于非网膜包裹组,术后胆漏(OR=0.30,95%CI:0.16~0.56,P<0.001)、术后出血(OR=0.35,95%CI:0.24~0.53,P<0.001)、胃排空障碍(OR=0.45,95%CI:0.31~0.64,P<0.001)、腹腔感染(OR=0.55,95%CI:0.40~0.75,P<0.001)、再次手术(OR=0.31,95%CI:0.18~0.54,P<0.001)、术后30天死亡(OR=0.42,95%CI:0.22~0.80,P=0.009)的发生率更低,开放饮食时间更早(MD=-0.98,95%CI:-1.84~-0.11,P=0.03)、术后住院时间更短(MD=-2.44,95%CI:-4.10~-0.77,P=0.004),两组手术方式在手术时间(MD=-13.68,95%CI:-28.31~0.95,P=0.07)及术中出血量(MD=-17.26,95%CI:-57.55~23.03,P=0.40)方面差异无统计学意义。结论网膜包裹可降低术后胰瘘、胆漏、出血、腹腔感染、胃排空障碍等术后并发症的发生率,改善患者预后,缩短住院时间,且不增加手术难度及手术时间。

Objective To systematically evaluate the efficacy and safety of omental wrapping technique for pancreaticojejunal anastomosis in preventing complications after pancreaticoduodenectomy.Methods This study was conducted according to the PRISMA guideline.English and Chinese databases including CNKI,Wanfang Data,VIP,CBM,the Cochrane Library,PubMed,Embase,and Web of Science were searched for clinical studies on omental wrapping technique for pancreaticojejunal anastomosis in preventing complications after pancreaticoduodenectomy published up to November 2022,and Stata 16 and Review Manager 5.4 were used to perform the meta-analysis.Results A total of 15 studies with 1830 patients were included in this study.The meta-analysis showed that the omental wrapping group had a significantly lower overall incidence rate of postoperative pancreatic fistula(POPF)than the non-omental wrapping group(odds ratio[OR]=0.30,95%confidence interval[CI]:0.22-0.41,P<0.001),and the subgroup analysis showed that the omental wrapping group had a significantly lower incidence rate of grade B/C POPF than the non-omental wrapping group(OR=0.29,95%CI:0.21-0.39,P<0.001).Compared with the non-omental wrapping group,the omental wrapping group had significantly lower incidence rates of postoperative bile leakage(OR=0.30,95%CI:0.16-0.56,P<0.001),postoperative hemorrhage(OR=0.35,95%CI:0.24-0.53,P<0.001),delayed gastric emptying(OR=0.45,95%CI:0.31-0.64,P<0.001),abdominal infection(OR=0.55,95%CI:0.40-0.75,P<0.001),reoperation(OR=0.31,95%CI:0.18-0.54,P<0.001),and death within 30 days after surgery(OR=0.42,95%CI:0.22-0.80,P=0.009),a significantly earlier time to diet(mean difference[MD]=−0.98,95%CI:−1.84 to−0.11,P=0.03),and a significantly shorter length of postoperative hospital stay(MD=−2.44,95%CI:−4.10 to−0.77,P=0.004).There were no significant differences between the two groups in the time of operation(MD=−13.68,95%CI:−28.31 to−0.95,P=0.07)and intraoperative blood loss(MD=−17.26,95%CI:−57.55 to−23.03,P=0.40).Conclusion Omental wrapping can reduce the incidence rates of postoperative complications such as pancreatic fistula,bile leakage,postoperative hemorrhage,abdominal infection,and delayed gastric emptying,improve the prognosis of patients,and shorten the length of hospital stay,without increasing surgical difficulty or time of operation.