胰十二指肠切除术后胰胃吻合和胰肠吻合安全性与疗效的Meta 分析
| 作者: |
1李连顺,
1李玉民,
1焦作义
1 兰州大学第二医院 普通外科/ 甘肃省消化系肿瘤重点实验室，甘肃 兰州 730030 |
| 通讯: | |
| DOI: | 10.3978/.10.3978/j.issn.1005-6947.2015.03.003 |
摘要
目的：系统评价胰胃吻合（PG）和胰肠吻合（PJ）两种胰十二指肠切除术（PD）后胰腺消化道吻合术 的安全性及疗效。 方法：检索国内外数据库中有关PD 术中应用PG 和PJ 的前瞻性随机对照试验，由2 名研究者独立进 行文献数据的提取，按照Cochrane Handbook 5.1 对纳入的文献进行严格的质量评价，并应用Review Manager 5.2 软件进行Meta 分析。 结果：共纳入7 篇文献，包括1 121 例患者，其中PG 组562 例，PJ 组559 例。Meta 分析结果显示，PG 组 在胰瘘（OR=0.60，95% CI=0.44~0.82，P=0.001）、胆瘘（OR=0.42，95% CI=0.18~0.93，P=0.03）、腹 腔积液（OR=0.50，95% CI=0.34~0.74，P=0.0005）发生率方面优于PJ 组；两组在胃排空障碍（OR=0.98， 95% CI=0.53~1.82，P=0.95）、术后腹腔出血（OR=1.29，95% CI=0.95~1.96，P=0.24）、二次手术率（OR=0.96， 95% CI=0.61~1.52，P=0.87）、病死率（OR=0.82，95% CI=0.43~1.58，P=0.56）方面差异无统计学意义。 结论： PD 在减少胰瘘、胆瘘、腹腔积液发生率方面较PJ 更有优势，但两者的安全性与远期疗效尚值 得进一步研究验证。
关键词：
胰十二指肠切除术
吻合术，外科
Meta 分析
Safety and efficacy of pancreaticogastrostomy and pancreaticojeunostomy after pancreaticoduodenectomy: a Meta-analysis
Abstract
Objective: To systematically evaluate the safety and efficacy of pancreaticogastrostomy (PG) and pancreaticojejunostomy (PJ) for pancreatico-digestive anastomosis after pancreaticoduodenectomy (PD). Methods: The prospective randomized controlled trials concerning application of PG and PJ in PD were collected by searching available national and international databases. Data were extracted by two independent reviewers, and the methodological quality of the included studies was evaluated according to the Cochrane handbook 5.1.Meta-analysis was performed using Manager 5.2 software. Results: A total of 7 studies were included involving 1 121 patients, with 562 cases in PG group and 559 cases in PJ group. Meta-analysis indicated that PG group was superior to PJ group with regard to the incidence of pancreatic fistula (OR=0.60, 95% CI=0.44–0.82, P=0.001), biliary fistula (OR=0.42, 95% CI=0.18–0.93, P=0.03) and intra-abdominal collection (OR=0.50, 95% CI=0.34–0.74, P=0.0005), while there was no significant difference between the two groups in respect to the incidence of delayed gastric emptying (OR=0.98, 95% CI=0.53–1.82, P=0.95) and postoperative intra-abdominal hemorrhage (OR=1.29, 95% CI=0.95–1.96, P=0.24), as well as the reoperation rate (OR=0.96, 95% CI=0.61–1.52, P=0.87) and mortality (OR=0.82, 95% CI=0.43–1.58, P=0.56). Conclusion: PG is superior to PJ in reducing the incidence of pancreatic fistula, biliary fistula and intra-abdominal collection, however, the safety and long-term efficacy of the two procedures still need further verification.
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