胃切除术后胰腺外分泌功能不全的meta分析

Pancreatic Exocrine Insufficiency After Gastrectomy:A Meta⁃analysis

背景:胃切除术后胰腺外分泌功能不全(PEI)可导致患者出现体质量减轻、腹泻、腹胀、脂肪吸收不良等症状,严重影响患者的生活质量。目的:探讨胃切除术后PEI的发生率以及胰酶替代治疗(PERT)的效果。方法:系统检索PubMed、Embase、Web of Science、中国知网、万方、维普数据库中关于胃切除术后PEI和(或)PERT疗效的相关研究,检索时间均为建库至2024年1月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险。采用Stata 12.0软件行meta分析。结果:共纳入16项研究、974例患者,其中14项研究报道了胃切除术后PEI发生率,2项报道了PERT的效果。胃切除术后PEI发生率为43.8%(95%CI:0.295~0.585)。亚组分析结果显示胃癌切除术后PEI发生率为82.1%(95%CI:0.541~0.991),全胃切除行Roux-en-Y术式重建和部分胃切除行Billroth Ⅱ术式重建的PEI发生率分别为60.4%(95%CI:0.489~0.719)和63.5%(95%CI:0.511~0.759),减重手术胆胰分流十二指肠开关术(BPD/DS)术式PEI发生率为67.3%(95%CI:0.542~0.804)。全胃切除术后PERT早期干预可减少24 h(SMD=-1.24,95%CI:-1.56~-0.91,P<0.001)和72 h(SMD=-1.41,95%CI:-1.74~-1.07,P<0.001)粪便脂肪含量,减少24 h粪便脂肪含量>7 g患者的例数(OR=0.21,95%CI:0.09~0.53,P=0.001)。结论:胃切除术后患者普遍发生PEI,临床医师应提高重视,尤其是对于胃癌胃切除术后、全胃切除行Roux-en-Y术式重建、部分胃切除行Billroth Ⅱ术式重建和减重手术行BPD/DS术式的患者。全胃切除术后患者可通过给予PERT改善PEI导致的脂肪吸收不良。

Background:Pancreatic exocrine insufficiency(PEI)after gastrectomy can lead to weight loss,diarrhea,abdominal distension,fat malabsorption and other symptoms,which seriously affects patients′quality of life.Aims:To investigate the incidence of PEI after gastrectomy and the efficacy of pancreatic enzyme replacement therapy(PERT).Methods:Studies on PEI after gastrectomy and/or efficacy of PERT were retrieved from PubMed,Embase,Web of Science,CNKI,Wanfang Data and VIP databases from the date of database establishment to January 2024.Two researchers independently screened the literature,extracted data,and assessed the risk of bias about included studies.Meta⁃analysis was conducted by Stata 12.0 software.Results:A total of 16 studies involving 974 patients were included in the meta⁃analysis,of which 14 studies reported the incidence of PEI after gastrectomy,and 2 studies reported the efficacy of PERT.The incidence of PEI after gastrectomy was 43.8%(95%CI:0.295⁃0.585).Subgroup analysis showed that the incidence of PEI after gastric cancer surgery was 82.1%(95%CI:0.541⁃0.991),the incidence of PEI in patients underwent total gastrectomy with Roux⁃en⁃Y reconstruction and partial gastrectomy with BillrothⅡreconstruction were 60.4%(95%CI:0.489⁃0.719)and 63.5%(95%CI:0.511⁃0.759),respectively,and the incidence of PEI after bariatric surgery with billiopancreatic diversion with duodenal switch(BPD/DS)was 67.3%(95%CI:0.542⁃0.804).Early intervention of PERT after total gastrectomy could reduce fecal fat content at 24 hours(SMD=-1.24,95%CI:-1.56⁃-0.91,P<0.001)and 72 hours(SMD=-1.41,95%CI:-1.74⁃-1.07,P<0.001),and the number of patients with 24⁃hour fecal fat content>7 g(OR=0.21,95%CI:0.09⁃0.53,P=0.001).Conclusions:PEI is common after gastrectomy,and clinicians should pay more attention on it,especially in gastric cancer patients undergoing gastrectomy,Roux⁃en⁃Y reconstruction after total gastrectomy,BillrothⅡreconstruction after partial gastrectomy and bariatric surgery with BPD/DS.Fat malabsorption caused by PEI in patients after total gastrectomy can be improved by PERT.