胰肠吻合口内引流与外引流在胰十二指肠切除术后疗效对比的Meta分析  

Comparison of clinical effect between internal and external drainage of pancreatic duct during pancreaticoduodenectomy: a Meta-analysis

作　　者：张明杰[1] 孟令勤[1] 张志深[1] 田忠[1] 刘源[1] 杨加鹏 ZHANG Ming-jie;MENG Ling-qin;ZHANG Zhi-shen;TIAN Zhong;LIU Yuan;YANG Jia-peng(Department of General Surgery,the Tenth Unit,Shengjing Hospital of China Medical University,Shenyang,Liaoning 110004,China)

机构地区：[1]中国医科大学附属盛京医院第十普通外科

出　　处：《肝胆胰外科杂志》2019年第12期746-752,760,共8页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的系统评价胰肠吻合口内引流与外引流对胰十二指肠切除术(PD)术后并发症的影响,重点分析对术后胰瘘的影响,为临床应用提供循证医学方面的客观依据。方法计算机检索Cochrane Library、PubMed、Embase、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)、维普和万方等数据库中关于胰肠吻合口内引流与外引流对比分析的相关文献。按Cochrane系统评价的方法评价纳入研究的质量,使用RevMan 5.3软件对研究资料进行统计分析。结果共纳入9篇文献,总计1 686例患者,其中内引流组932例,外引流组754例。Meta分析结果显示:所有纳入文献中内引流组与外引流组术后胰瘘发生率(OR 0.02,95%CI 0.08~0.3)差异没有统计学意义(P=0.44)。去除相关干扰因素,进行各种亚组分析后,结果依然是两种引流方式术后胰瘘发生率差异没有统计学意义(P>0.05),其他术后并发症发生率也没有统计学差异(P>0.05)。结论胰肠吻合口内引流与外引流对PD术后并发症的影响没有差异,术者应根据患者具体情况,选取自己比较熟练而且对患者比较安全的引流方式。Objective To systematically evaluate the effect of internal and external drainage of pancreatic duct on postoperative complications of pancreatoduodenectomy(PD), especially the influence on postoperative pancreatic fistula(PF), to provide evidence-based medicine for clinical application. Methods The literatures on efficiency comparision of internal and external drainage of pancreatic duct during pancreaticoduodenectomy were searched from Cochrane Library, Pub Med database, Embase database, Web of Science, Chinese biomedicine database, CNKI database, VIP database and Wanfang database. Quality of the included studies was assessed according to the Cochrane systematic review method. Statistical analysis was performed with Rev Man 5.3 software. Results Nine studies were included, with a total of 1 686 patients, among whom 932 cases underwent internal drainage of pancreatic duct and 754 cases underwent external drainage of pancreatic duct. Meta-analysis showed that there was no significant difference in the incidence of postoperative PF(OR 0.02, 95%CI 0.08~0.3) between the two groups(P=0.44). After removing relevant interfering factors and performing various subgroup analyses, the result was still that no statistical difference existed in the incidence of postoperative PF between the two methods(P>0.05), and there was no statistical difference in the incidence of other major postoperative complications. Conclusion There is no difference in the incidence of postoperative complications between internal and external drainage of pancreatic duct during pancreaticoduodenectomy. Surgeon may choose the method that is more proficient and safer for patient according to the specific condition.

关 键 词：胰十二指肠切除术 胰肠吻合 胰管引流 胰瘘 META分析 

分 类 号：R657.5[医药卫生—外科学]