摘要
目的 通过纳入最新随机对照试验（RCT）文献对胰十二指肠切除术后采用胰胃吻合（PG）与胰肠吻合术（PJ）的手术相关并发症和安全性进行系统评价.方法 计算机检索2004年1月1日至2014年3月31日Medline、EMBASE、Science Direct、Springer link、CBM、中国知网、万方以及维普数据库收录的比较胰十二指肠切除术后胰胃吻合术与胰肠吻合术的RCT文献.纳入文献由2位研究者独立筛选（PRISMA标准）.资料提取和方法学质量评价后,采用RevMan 5.2.7软件进行Meta分析.结果 分析共纳入6篇前瞻性RCT研究.纳入文献的病例总数为976例,其中行PG手术489例,行PJ手术487例.Meta分析显示：PG术后胰瘘（RR：0.51;95％ CI：0.37-0.70;P＜0.01）、腹腔积液（RR：0.55;95％ CI：0.34-0.89;P=0.01）及胆瘘（RR：0.14;95％ CI：0.03-0.59;P =0.0008）的发生率低于PJ,在术后并发症发生、病死率、胃排空障碍、术后出血、再手术、术后住院时间等方面,PG和PJ差异无统计学意义（P＞0.05）.结论 胰十二指肠切除术后PG在安全性和可行性方面优于PJ,但此结果仍需多中心、大样本、前瞻性RCT研究验证.
Objective To evaluate the postoperative complications and safety of pancreaticogastrostomy （PG） versus pancreaticojejunostomy （PJ） after pancreaticoduodenectomy （PD）.Methods Medline,EMBASE,Science Direct,Springer link,CBM,Cnki,Wan fang and VIP database were retrieved by computer search between 1st January 2004 and 31st March 2014 to collect all the RCT articles on pancreaticojejunostomy versus pancreaticogastrostomy after pancreaticoduodenectomy.The quality of the included trials was studied by assessing the inclusive and exclusive criteria （the PRISMA statement） by 2 researchers independently,then the data were extracted and analyzed using the RevMan 5.2.10 software.Results A total of 6 prospective randomized controlled trials which involved 976 patents were included in the study.There were significant differences between PG and PJ in terms of postoperative pancreatic fistula （RR：0.51 ; 95 % CI：0.37-0.70 ; P 〈 0.0001）,intra-abdominal fluid collection （RR：0.55 ; 95 % CI：0.34-0.89; P =0.01）,and postoperative biliary fistula （RR：0.14; 95% CI：0.03-0.59; P =0.0008）.There was no significant difference in postoperative complications,mortality,delayed gastric emptying,postoperative hemorrhage,reoperation and length of hospital stay （P 〉 0.05）.Conclusions Pancreaticogastrostomy after pancreaticoduodenectomy is superior to pancreaticojejunostomy in safety and practicability.However,large,multicenter prospective randomized controlled trials are still needed to confirm the findings of this meta-anlaysis.
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2014年第8期590-594,共5页
Chinese Journal of Hepatobiliary Surgery
