胰十二指肠切除术胰肠、胰胃两种吻合方式的Meta分析

目的 比较胰十二指肠切除术后采用胰胃吻合术与采用胰空肠吻合术在围手术期死亡率、术后并发症发生率、术后胰瘘、胃排空延迟、出血、腹腔积液、二次手术等方面有无明显差异.方法 计算机检索PubMed、Cochrane Library、Medline、Embase等数据库,同时根据以上检索所得文献的参考文献进行扩大检索.使用Jadad法进行质量评价,采用Cochrane协作网提供的RevMan5.2.7统计软件进行Meta分析.结果 共纳入8项研究,共计1211例病人.结果显示,胰胃吻合组（PG）与胰空肠吻合组（PJ）相比,在围手术期并发症发生率、围手术期死亡率、胃排空延迟、出血以及二次手术方面并差异无统计学意义.而在术后胰瘘及腹腔积液方面,PG组优于PJ组,差异具有统计学意义.结论 胰胃吻合术的安全性不亚于胰空肠吻合术,并可在一定程度上降低术后胰瘘以及腹腔积液的发生率.但是尚需要更多相关的高质量临床研究,以进一步对PG及PJ两种术式进行比较.

Pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy: a meta-analysis

Objective To evaluate the clinical efficacy and safety of pancreaticogastrostomy （PG） versus pancreaticojejunostomy （PJ） after pancreaticoduodenectomy.Methods The relevant literature reports were retrieved from the databases of PubMed,Cochrane Library,Medline and Embase.And exploding search was performed for the references of retrieved articles.The quality of included trials was assessed by Jadad method.The Review Manager software （version 5.2.7） was used for statistical analyses.Results Eight studies involved a total of 1211 patients.Meta-analysis showed no significant difference in perioperative morbidities,perioperative mortalities,delayed gastric emptying,hemorrhage and reoperation.And postoperative pancreatic fistula and intra-abdominal fluid collection significantly decreased in patients undergoing pancreaticogastrostomy.Conclusions As safe as pancreaticojejunostomy,pancreaticogastrostomy after pancreaticoduodenectomy may reduce the occurrence rates of postoperative pancreatic fistula and intra-abdominal fluid collection.However,more robust multicenter randomized controlled trials are warranted.