保留幽门的胰十二指肠切除术后施行结肠前与结肠后十二指肠空肠吻合效果比较的Meta分析  

Comparison on Effectiveness of Antecolic Duodenojejunostomy and Retrocolic Duodenojejunostomy after Pylorus-Preserving Pancreaticoduodenectomy:A Meta-Analysis

作　　者：徐明[1] 沈火剑[1] 朱宏毅[1] 杨超[1] 施维锦[1] 季福[1] 

机构地区：[1]上海交通大学医学院附属仁济医院胆胰外科,上海200127

出　　处：《中国普外基础与临床杂志》2014年第12期1537-1543,共7页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的比较保留幽门的胰十二指肠切除术（PPPD）后采用结肠前十二指肠空肠吻合（ADJ）与结肠后十二指肠空肠吻合（RDJ）的效果。方法计算机检索Cochrane Library、Pub Med数据库、Embase数据库、Web of Science、中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）、维普和万方数据库中关于PPPD后ADJ和RDJ效果的文献,检索时间均为建库至2014年4月。同时在Google搜索引擎进行检索,追查纳入研究的参考文献。根据Cochrane协作网推荐的＂风险评估工具＂进行偏倚风险评估后,采用Rev Man 5.1软件进行Meta分析。结果共纳入4个随机对照研究,共462例患者。Meta分析结果显示,ADJ组和RDJ组的手术时间（MD=14.02,95%CI：-41.42-69.46,P=0.62）、术后总并发症发生率（RR=1.09,95%CI：0.81-1.48,P=0.56）、胃排空延迟发生率（RR=0.63,95%CI：0.31-1.28,P=0.20）、胰瘘发生率（RR=1.13,95%CI：0.72-1.75,P=0.60）、腹腔脓肿发生率（RR=0.92,95%CI：0.54-1.58,P=0.77）及死亡率（RR=0.61,95%CI：0.24-1.60,P=0.32）比较差异均无统计学意义。结论 PPPD后施行ADJ和RDJ的效果并无明显差异,外科医生可以按照自己的偏好进行吻合方式的选择。Objective To compare the effectiveness of antecolic duodenojejunostomy （ADJ） and retrocolic duodenojejunostomy （RDJ） after pylorus-preserving pancreaticoduodenectomy （PPPD）. Methods Randomized controlled trials （RCTs） of ADJ versus RDJ after PPPD were searched in Cochrane Library, PubMed database, Embase database, Web of Science, Chinese biomedicine database, CNKI database, VIP database, and Wanfang database from inception to April 2014, as well as Google. Atier quality assessment of RCTs according to the Cochrane Handbook for Systematic Reviews of Interventions Version, Meta analysis was performed by RevMan 5.1 software. Results Four RCTs of 462 patients in total were included in this Meta-analysis. The results of Meta-analysis showed that, there were no significant differences in the operation time （MD=14. 02, 95% CI： -41.42-69. 46, P=-0. 62）, incidence of postoperative complications （RR=1. 09, 95% CI： 0. 81-1.48, P=0.56）, incidence of delayed gastric emptying （RR=0, 63, 95% CI： 0. 31- 1.28, P=0. 20）, incidence of pancreatic fistula （RR=1. 13, 95% CI： 0. 72-1.75, P=0. 60）, incidence of abdominal abscess （RR=0. 92, 95% CI： 0. 54-1.58, P=0. 77）, and mortality （RR=0. 61, 95% CI： 0. 24-1.60, P=0. 32） between ADJ group and RDJ group. Conclusions The effectiveness of ADJ is similar with RDJ after PPPD, so the reconstruction way after PPPD can be routed according to the surgeon＇s preference.

关 键 词：保留幽门的胰十二指肠切除术 十二指肠空肠吻合 胃排空延迟 META分析 

分 类 号：R656.6[医药卫生—外科学]