摘要
目的 通过Meta分析的方法,比较胰管支架内、外引流两种方式预防胰十二指肠切除术后并发症的疗效.方法 计算机检索Pubmed、Embase、The Cochrane Library数据库,检索所有与胰管支架在胰十二指肠切除术中使用的相关的随机对照试验.检索截止时间为2015年3月31日.两名研究者分别对研究进行回顾分析并提取试验数据.使用Cochrane协作网的RevMan 5.3软件进行数据分析.结果 共纳入3个随机对照试验研究,362例患者.研究结局分为主要和次要结局指标.主要结局指标包括术后胰瘘发病率和术后延迟性胃排空;次要结局指标包括术后总病死率、术后总并发症发病率和术后肠梗阻发病率.Meta分析结果提示：（1）3个随机对照试验研究了术后总胰瘘（A/B/C级）发生情况,提示外引流较内引流更能减少术后胰瘘,差异有统计学意义（OR=0.59,95％ CI：0.36 ～0.97,P=0.04）.（2）3个随机对照试验研究了术后B、C级胰瘘发生情况,提示外引流较内引流更能减少术后胰瘘（B/C级）,差异有统计学意义（OR =0.44,95％ CI：0.20 ～0.97,P=0.04）.（3）3个随机对照试验研究了术后延迟性胃排空的发生情况,提示外引流较内引流更能减少术后延迟性胃排空的发生,差异有统计学意义（OR=0.42,95％ CI：0.23～0.79,P=0.007）.（4）3个随机对照试验研究了术后总病死率的发生情况,提示外引流与内引流比较,差异没有统计学意义（OR =0.81,95％ CI：0.23 ～2.86,P=0.74）,尚不能认为这两种引流方式有差异.（5）在术后总并发症发病率和术后肠梗阻方面,由于异质性相对较大（＞50％）,分析其异质性可能源于研究间围手术期处理方式不同所致.采用随机效应模型进行分析,未发现明显统计学差异.结论 胰管支架外引流与内引流相比较,可以更有效地降低胰十二指肠切除术后胰瘘和延迟性胃排空并发症的发病率.
Objective To compare the effect of pancreatic duct stent internal versus external drainage in the prevention of postoperative complications after pancreaticoduodenectomy through the method of Meta analysis.Methods PubMed,Embase and the Cochrane Library,were searched for randomized controlled trials （RCTs） concerning pancreatic duct stent in the prevention of postoperative complications after pancreaticoduodenectomy.All these databases were searched from their establishment to March 31,2015.The data was reviewed and extracted by two investigators independently.Then,the Cochrane network RevMan 5.3 software was used for statistic analysis.Results As a result,this meta analysis has got 3 RCTs,including 362 participants.The outcomes in our study design were classified as major and minor one.The former was the outcomes of the major postoperative complications,like postoperative pancreatic fistula and delayed gastric emptying.The minor outcome were postoperative morbidity,mortality and intestinal obstruction.The results of meta analysis were：（1） Postoperative total pancreatic fistula rate （A/B/C）：three studies showed a statistic difference between the internal and external drainage groups （OR =0.59,95%CI：0.36-0.97,P =0.04）.（2） Postoperative pancreatic fistula rate （B/C）：three studies showed a statistic difference between the internal and external drainage groups （OR =0.44,95% CI：0.20-0.97,P =0.04）.（3） Postoperative incidence rate of delayed gastric emptying：three studies showed a certain statistic difference between the internal and external drainage groups （OR =0.42,95 % CI：0.23-0.79,P =0.007）.（4） Post-operative incidence rate of total mortality：three studies showed no certain statistic difference between the internal and external drainage groups （OR =0.81,95 % CI：0.23-2.86,P =0.74）.（5） As for the postoperative incidence rate of total complications and intestinal obstruction,the heterogeneity was bigger than 50%.So we made an analysis of the cause of heterogeneity.We deduced that it may be caused by the different and complicated perioperative management.Then,we used the random effect model rather than the fixed effect model to make a quantitative analysis.No statistical difference was found eventually in both this two marks.Conclusions By comparing the outcomes in both internal and external drainage groups,we found pancreatic duct stent external drainage could effectively decrease the incidence rate of postoperative pancreatic fistula rate and delayed gastric emptying.But when the limit studies and sample size considered,this conclusion still need to be certificated with more high-quality clinical research.
出处
《国际外科学杂志》
2015年第6期388-393,F0003,共7页
International Journal of Surgery
关键词
胰瘘
胰十二指肠切除术
支架
引流
META分析
Pancreatic fistula
Pancreaticoduodenectomy
Stents
Drainage
Meta-analysis
