基于临床随机对照试验的胰十二指肠切除术后消化道重建方式的系统评价  

Reconstruction methods of digestive tract after pancreaticodudenectomy：a systematic review and meta-analysis of RCTs

作　　者：雷普润 魏波[1] 方佳峰[1] 刘建培[1] 区广生[1] 黄利军[1] 卫洪波[1] 

机构地区：[1]中山大学附属第三医院胃肠外科,广州510630

出　　处：《中华胃肠外科杂志》2014年第10期1002-1008,共7页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的：系统评价胰十二指肠切除术（PD术）后不同的消化道吻合方式及相关辅助方法。方法检索万方数据库和PubMed、The Cochrane Library、Web of Science以及EMBASE等数据库中，关于PD手术后消化道吻合方式的临床随机对照试验（RCT），采用Jadad量表对纳入文献进行质量分析，提取围手术期情况：包括手术时间、术中出血量、术后发生胰漏、胆漏、出血、胃排空延迟、死亡率、再次手术以及伤口愈合不良等并发症指标，采用RevMan 5．2软件进行Meta分析。结果17篇RCT研究共计2504例病例纳入分析，Meta分析结果显示，胰胃吻合组术后胰漏和胆漏的发生率明显低于胰肠吻合组（OR＝0．60，95％ CI：0．44～0．82，P＝0．00； OR＝0．33，95％ CI：0．13～0．82， P＝0．02）。胰肠吻合组中，胰管-黏膜吻合术与传统端端吻合术后总体并发症发生率以及术后胰漏、再次手术和围手术期死亡的发生率差异均无统计学意义（P＞0．05）。外支架管引流组的术后总体并发症发生率及胰漏、尤其是Ⅱ～Ⅲ级胰漏的发生率和住院时间均明显低于无支架管引流组（均P＜0．05）。结论 PD术后消化道重建方式，推荐采用胰胃吻合，辅以外支架管引流。Objective To investigate different types of anastomosis and reconstruction techniques after pancreaticodudenectomy with meat-analysis. Methods Systematically literature search was performed through Wanfang, PubMed, EMBASE, Web of Science and Cochrane Library database without restriction to regions, publication types, or languages. A total of 17 randomized controlled trials met the criteria and were evaluated by Jadad scale. Fixed and random-effects models were used to measure the pooled estimates, including pancreatic fistula, bile leakage, hemorrhage, delay gastric emptying （DGE）, mortality, reoperation. Results Meta analysis revealed that patients undergoing pancreaticogastrostomy had a lower incidence of pancreatic fistula and bile leakage （OR=0.60,95% CI：0.44-0.82,P=0.001; OR=0.33,95% CI：0.13-0.82,P=0.02） as compared to pancreaticojejunostomy. In pancreaticoenterostomy group, pancreatic duct-mucosa pancreaticoenterostomy had no significant differences with traditional end-to-end anastomosis in terms of overall postoperative morbidity, and development of postoperative pancreatic fistula, reoperation, perioperative death. External stent placement drainage group had a lower postoperative overall complication rate and incidence of pancreatic fistula, especially the Ⅱ-Ⅲ grade pancreatic fistula, and a shorter hospital stay than non-stent drainage group （all P〈0.05）. Conclusions Pancreaticogastrostomy should be recommended as digestive tract reconstruction after pancreaticodudenectomy and assistant external stent drainage is also necessary.

关 键 词：胰十二指肠切除术 消化道重建 胰肠吻合 胰胃吻合 支架 胰漏 Meta分析 

分 类 号：R656[医药卫生—外科学]