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胰十二指肠切除术胰肠吻合方式与胰漏发生相关性的Meta分析

A meta-analysis of pancreaticojejunostomy on pancreatic fistula after pancreaticoduodenectomy

摘要:

目的 评价不同胰肠吻合方式对胰十二指肠切除术后胰漏发生率的影响.方法 通过计算机检索PubMed数据库、EMBase数据库、COCHRANE Library、中国期刊全文数据库、万方数据库及维普中文科技期刊数据库,并结合文献追溯的方法,收集2013年9月以前发表的关于胰肠吻合在胰十二指肠切除术后临床疗效的前瞻性随机对照试验和前瞻性非随机对照试验.对符合纳入条件的文献运用Review Manager 5.0软件进行统计分析.结果 共有8篇文献符合纳入标准,其中5篇关于套入式胰肠吻合与胰管对黏膜端侧胰肠吻合临床疗效的文献.研究结果显示,二者对术后胰漏发生率(M-H法:OR =0.77,95% CI:0.35 ~ 1.69,P=0.52)、再手术率(M-H法:OR=1.38,95% CI:0.64 ~2.95,P=0.41)及围手术期死亡率(M-H法:OR=1.15,95% CI:0.42~3.13,P=0.79)的影响无统计学意义;3篇关于捆绑式胰肠吻合与常规胰肠吻合(包括套入式胰肠吻合与胰管对黏膜端侧胰肠吻合)临床疗效比较的文献,研究结果显示,捆绑式胰肠吻合与常规胰肠吻合对术后胰漏发生率(M-H法:OR =0.57,95% CI =0.28 ~ 1.17,P=0.13)、再手术率(M-H法:OR=1.18,95% CI=0.48~2.92,P=0.72)及围手术期死亡率(M-H法:OR=0.74,95%CI=0.27 ~ 1.99,P=0.55)的影响无统计学意义.结论 胰十二指肠切除术捆绑式胰肠吻合与常规胰肠吻合、胰管对黏膜端侧吻合与套入式胰肠吻合对术后胰漏的发生率、再手术率及围手术期死亡率的影响无差异.

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abstracts:

Objective To evaluate the pancreatic fistula affected by different type of pancreaticojejunostomy after pancreaticoduodenectomy.Methods Electronic databases PubMed,EMBase,COCHRANE Library,Wanfang,and VIP etc were used to search for randomized controlled trials or non randomized prospective controlled trials reported before September 2013 on clinical effects of pancreaticojejunostomy after pancreaticoduodenectomy.The statistical analysis was done by Review Manager 5.0.Results A total of 8 trials were included in this meta-analysis.The effects of duct-to-mucosa pancreaticojejunostomy (dmPJ) and invaginating pancreaticojejunostomy (iPJ) on postoperative complication in five studies were compared,and no statistical significance were found in postoperative pancreatic fistula (POPF) (M-H:OR =0.77,95% CI:0.35-1.69,P =0.52),reoperation (M-H:OR =1.38,95% CI:0.64-2.95,P =0.41) and mortality (M-H:OR =1.15,95 % CI:0.42-3.13,P =0.79) between dmPJ and iPJ.The effects of binding pancreaticojejunostomy (bPJ) and conventional pancreaticojejunostomy (cPJ) (including duct-to-mucosa pancreaticojejunostomy and invaginating pancreaticojejunostomy) on postoperative complication were compared,and no statistical significance were found in postoperative pancreatic fistula (POPF)(M-H:OR=0.57,95% CI =0.28-1.17,P =0.13),reoperation(M-H:OR =1.18,95% CI =0.48-2.92,P =0.72) and mortality (M-H:OR =0.74,95% CI =0.27-1.99,P =0.55) between bPJ and cPJ.Conclusion There are no significant differences between dmPJ and iPJ in pancreatic fistula reoperation and mortality,and there are also no significant differences between bPJ and cPJ.

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