胰十二指肠切除不同胰肠吻合术后胰瘘的Meta分析
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摘要
目的:系统评价胰管空肠黏膜吻合和套入式吻合对胰十二指肠切除术后胰瘘发生的影响。方法:在中外生物医学数据库检索相关文献,文献质量评价参考Jadad质量评分系统,Meta分析采用RevMan 5.3软件。结果:共纳入11篇文献,胰管空肠黏膜吻合591例,胰管空肠套入式吻合607例。结果显示:两组的总胰瘘发生率[RR=0.83,95%CI:0.65～1.06,P=0.14]、A级胰瘘发生率[RR=1.40,95%CI:0.90～2.19,P=0.13]、B[RR=0.95,95%CI:0.40～2.30,P=0.92]、软胰和硬胰的胰瘘发生率[RR=1.06,95%CI:0.79～1.43,P=0.68]、[RR=1.14,95%CI:0.80～1.62,P=0.47]差异均无统计学意义。结论:胰十二指肠切除中两种胰肠吻合术后胰瘘的发生率无明显差异。
Objective:To systematically evaluate the effect of duct-to-mucosa and invagination pancreaticojejunostomy on pancreatic fistula after pancreatoduodenectomy. Methods:The relevant literature was searched in Chinese and foreign biomedical databases. The quality assessment of the literature was based on the Jadad quality scoring system. Meta analysis was performed using RevMan 5.3 software. Results:A total of 11 articles were included. There were 591 cases of duct-to-mucosa group and 607 cases of invagination group. Meta analysis showed: incidence of total pancreatic fistula[RR=0.83, 95% CI: 0.65-1.06, P=0.14], incidence of pancreatic fistula A[RR=1.40, 95% CI:0.90-2.19, P=0.13], incidence of pancreatic fistula B[RR=0.65, 95% CI: 0.19-2.21, P =0.49], incidence of pancreatic fistula C[RR=0.95, 95% CI: 0.40-2.30, P=0.92], incidence of soft and hard pancreas pancreatic fistula[RR = 1.06, 95% CI: 0.79-1.43, P =0.68],[RR =Conclusion:There is no significant difference in the incidence of pancreatic fistula after pancreatoduodenectomy between two kinds of pancreaticojejunostomy.
Objective:To systematically evaluate the effect of duct-to-mucosa and invagination pancreaticojejunostomy on pancreatic fistula after pancreatoduodenectomy. Methods:The relevant literature was searched in Chinese and foreign biomedical databases. The quality assessment of the literature was based on the Jadad quality scoring system. Meta analysis was performed using RevMan 5.3 software. Results:A total of 11 articles were included. There were 591 cases of duct-to-mucosa group and 607 cases of invagination group. Meta analysis showed: incidence of total pancreatic fistula[RR=0.83, 95% CI: 0.65-1.06, P=0.14], incidence of pancreatic fistula A[RR=1.40, 95% CI:0.90-2.19, P=0.13], incidence of pancreatic fistula B[RR=0.65, 95% CI: 0.19-2.21, P =0.49], incidence of pancreatic fistula C[RR=0.95, 95% CI: 0.40-2.30, P=0.92], incidence of soft and hard pancreas pancreatic fistula[RR = 1.06, 95% CI: 0.79-1.43, P =0.68],[RR =Conclusion:There is no significant difference in the incidence of pancreatic fistula after pancreatoduodenectomy between two kinds of pancreaticojejunostomy.
引文
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[9]BAI X,ZHANG Q,GAO S,et al.Duct-to-Mucosa vs Invagination for Pancreaticojejunostomy after Pancreaticoduodenectomy:A Prospective,Randomized Controlled Trial from a Single Surgeon[J].J Am Coll Surg,2016,222(1):10-18.
[10]张宇,杨洪吉,邓小凡,等.袖套式prolene线单层连续缝合在胰肠吻合中的应用[J].中国普通外科杂志,2015,24(3):312-318.
[11]LANGREHR J M,BAHRA M,JACOB D,et al.Prospective randomized comparison between a new mattress technique and Cattell(duct-to-mucosa)pancreaticojejunostomy for pancreatic resection[J].World J Surg,2005,29(9):1111-1119.
[12]CHOU F F,SHEEN-CHEN S M,CHEN Y S,et al.Postoperative morbidity and mortality of pancreaticoduodenectomy for periampullary cancer[J].Acta chirurgica,1996,162(6):477-481.
[13]BASSI C,DERVENIS C,BUTTURINI G,et al.Postoperative pancreatic fistula:An international study group(IS-GPF)definition[J].Surgery,2005,138(1):8-13.
[14]MURAKAMI Y,UEMURA K,HAYASHIDANI Y,et al.No mortality after 150 consecutive pancreatoduodenctomies with duct-to-mucosa pancreaticogastrostomy[J].JSurg Oncol,2008,97(3):205-209.
[15]CHANG Y R,KANG J S,JANG J Y,et al.Prediction of Pancreatic Fistula After Distal Pancreatectomy Based on Cross-Sectional Images[J].World J Surg,2017,41(6):1610-1617.
[16]ZHANG L,XIU D,YUAN C,et al.Pancreatic duct obstruction after pancreaticojejunostomy:implications for early prediction and prevention of long-term pancreatic complications[J].BMC Gastroenterol,2018,18(1):53.
[17]LAI E C,LAU S H,LAU W Y.Measures to prevent pancreatic fistula after pancreatoduodenectomy:a comprehensive review[J].Arch Surg,2009,144(11):1074-1080.
[18]TEE M C,KENDRICK M L,FARNELL M B.Laparoscopic Pancreaticoduodenectomy:Is It an Effective Procedure for Pancreatic Ductal Adenocarcinoma?[J].Adv Surg,2015,49:143-156.
[19]翟振洪,白军军,季德刚.胰十二指肠切除术后胰瘘的诊断及危险因素[J].中国实验诊断学,2018,22(4):751-754.
[20]杜羽升,赵文星.腹腔镜胰十二指肠切除术胰消化道重建方式的进展[J].腹腔镜外科杂志,2018,23(2):148-151.
[21]LIU Z B,YANG Y M,GAO S,et al.Surgical complications after pancreatoduodenectomy:risk factors and treatments[J].Zhonghua Wai Ke Za Zhi,2010,48(18):1392-1397.
[22]WAYNE M G,JORGE I A,COOPERMAN A M.Alternative reconstruction after pancreaticoduodenectomy[J].World Journal of Surgical Oncology,2008,6(1):9.
[23]DUAN X,JIANG B,ZHOU L,et al.Laparoscopic Pancreaticoduodenectomy:A Single Team Preliminary Experience[J].Surg Laparosc Endosc Percutan Tech,2017,27(5):356-360.
[24]中华医学会外科学分会胰腺外科学组,中国医疗保健国际交流促进会胰腺病分会胰腺微创治疗学组,中国研究型医院学会胰腺疾病专业委员会胰腺微创学组,等.腹腔镜胰十二指肠切除手术专家共识(附:手术流程与主要步骤)[J].中华外科杂志,2017,55(5):335-339.
[25]邵宇,舒武英,黎蒙,等.直肠癌腹腔镜根治术与传统根治术的对比研究[J].大理大学学报,2017,2(8):31-34.
[26]WANG W,ZHANG Z,GU C,et al.The optimal choice for pancreatic anastomosis after pancreaticoduodenectomy:Anetwork meta-analysis of randomized control trials[J].International Journal of Surgery,2018,57:111-116.
[27]CALLERY M P,PRATT W B,KENT T S,et al.A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy[J].J Am Coll Surg,2013,216(1):1-14.
[28]MILLER B C,CHRISTEIN J D,BEHRMAN S W,et al.Amulti-institutional external validation of the fistula risk score for pancreatoduodenectomy[J].J Gastrointest Surg,2014,18(1):172-179.
[2]毕涛,李勇,王静,等.胰十二指肠切除术中两种胰肠吻合方式疗效比较[J].肝胆胰外科杂志,2013,25(6):441-443.
[3]韩建明,王新波,全竹富,等.胰十二指肠切除术后胰管空肠黏膜吻合对胰瘘发生率的影响[J].医学研究生学报,2009,22(9):961-964.
[4]区军杰.胰管空肠黏膜吻合与胰肠套入式吻合对胰十二指肠切除术后胰瘘对照研究[J].中外医疗,2015,34(32):46-48.
[5]华小斌,付强,佘明杰,等.胰腺-空肠套入式吻合与胰管-空肠黏膜吻合对胰十二指肠切除术术后并发症发生情况的影响[J].安徽医学,2016,37(4):405-409.
[6]BASSI C,FALCONI M,MOLINARI E,et al.Duct-to-mucosa versus end-to-side pancreaticojejunostomy reconstruction after pancreaticoduodenectomy:results of a prospective randomized trial[J].Surgery,2003,134(5):766-771.
[7]BERGER A C,HOWARD T J,KENNEDY E P,et al.Does type of pancreaticojejunostomy after pancreaticoduodenectomy decrease rate of pancreatic fistula?A randomized,prospective,dual-institution trial[J].J Am Coll Surg,2009,208(5):738-747.
[8]EL NAKEEB A,EL HEMALY M,ASKR W,et al.Comparative study between duct to mucosa and invagination pancreaticojejunostomy after pancreaticoduodenectomy:a prospective randomized study[J].Int J Surg,2015,16(Pt A):1-6.
[9]BAI X,ZHANG Q,GAO S,et al.Duct-to-Mucosa vs Invagination for Pancreaticojejunostomy after Pancreaticoduodenectomy:A Prospective,Randomized Controlled Trial from a Single Surgeon[J].J Am Coll Surg,2016,222(1):10-18.
[10]张宇,杨洪吉,邓小凡,等.袖套式prolene线单层连续缝合在胰肠吻合中的应用[J].中国普通外科杂志,2015,24(3):312-318.
[11]LANGREHR J M,BAHRA M,JACOB D,et al.Prospective randomized comparison between a new mattress technique and Cattell(duct-to-mucosa)pancreaticojejunostomy for pancreatic resection[J].World J Surg,2005,29(9):1111-1119.
[12]CHOU F F,SHEEN-CHEN S M,CHEN Y S,et al.Postoperative morbidity and mortality of pancreaticoduodenectomy for periampullary cancer[J].Acta chirurgica,1996,162(6):477-481.
[13]BASSI C,DERVENIS C,BUTTURINI G,et al.Postoperative pancreatic fistula:An international study group(IS-GPF)definition[J].Surgery,2005,138(1):8-13.
[14]MURAKAMI Y,UEMURA K,HAYASHIDANI Y,et al.No mortality after 150 consecutive pancreatoduodenctomies with duct-to-mucosa pancreaticogastrostomy[J].JSurg Oncol,2008,97(3):205-209.
[15]CHANG Y R,KANG J S,JANG J Y,et al.Prediction of Pancreatic Fistula After Distal Pancreatectomy Based on Cross-Sectional Images[J].World J Surg,2017,41(6):1610-1617.
[16]ZHANG L,XIU D,YUAN C,et al.Pancreatic duct obstruction after pancreaticojejunostomy:implications for early prediction and prevention of long-term pancreatic complications[J].BMC Gastroenterol,2018,18(1):53.
[17]LAI E C,LAU S H,LAU W Y.Measures to prevent pancreatic fistula after pancreatoduodenectomy:a comprehensive review[J].Arch Surg,2009,144(11):1074-1080.
[18]TEE M C,KENDRICK M L,FARNELL M B.Laparoscopic Pancreaticoduodenectomy:Is It an Effective Procedure for Pancreatic Ductal Adenocarcinoma?[J].Adv Surg,2015,49:143-156.
[19]翟振洪,白军军,季德刚.胰十二指肠切除术后胰瘘的诊断及危险因素[J].中国实验诊断学,2018,22(4):751-754.
[20]杜羽升,赵文星.腹腔镜胰十二指肠切除术胰消化道重建方式的进展[J].腹腔镜外科杂志,2018,23(2):148-151.
[21]LIU Z B,YANG Y M,GAO S,et al.Surgical complications after pancreatoduodenectomy:risk factors and treatments[J].Zhonghua Wai Ke Za Zhi,2010,48(18):1392-1397.
[22]WAYNE M G,JORGE I A,COOPERMAN A M.Alternative reconstruction after pancreaticoduodenectomy[J].World Journal of Surgical Oncology,2008,6(1):9.
[23]DUAN X,JIANG B,ZHOU L,et al.Laparoscopic Pancreaticoduodenectomy:A Single Team Preliminary Experience[J].Surg Laparosc Endosc Percutan Tech,2017,27(5):356-360.
[24]中华医学会外科学分会胰腺外科学组,中国医疗保健国际交流促进会胰腺病分会胰腺微创治疗学组,中国研究型医院学会胰腺疾病专业委员会胰腺微创学组,等.腹腔镜胰十二指肠切除手术专家共识(附:手术流程与主要步骤)[J].中华外科杂志,2017,55(5):335-339.
[25]邵宇,舒武英,黎蒙,等.直肠癌腹腔镜根治术与传统根治术的对比研究[J].大理大学学报,2017,2(8):31-34.
[26]WANG W,ZHANG Z,GU C,et al.The optimal choice for pancreatic anastomosis after pancreaticoduodenectomy:Anetwork meta-analysis of randomized control trials[J].International Journal of Surgery,2018,57:111-116.
[27]CALLERY M P,PRATT W B,KENT T S,et al.A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy[J].J Am Coll Surg,2013,216(1):1-14.
[28]MILLER B C,CHRISTEIN J D,BEHRMAN S W,et al.Amulti-institutional external validation of the fistula risk score for pancreatoduodenectomy[J].J Gastrointest Surg,2014,18(1):172-179.