胰十二指肠切除术后胰胃吻合术与胰空肠吻合术前瞻性对照试验的荟萃分析

目的 比较胰十二指肠切除术(PD)后胰胃吻合术(PG)与胰空肠吻合术(PJ)的安全性.方法 检索2010年12月以前EMBASE、MEDLINE、Cochrane Library、Cochrane协作网随机对照试验注册数据库、中国期刊全文数据库(CNKI)、中国生物文献数据库(CBM)等数据库,纳入前瞻性对照试验,评估文献质量并提取数据资料,应用RevMan5.0对其进行荟萃分析.结果 纳入6个前瞻性对照试验,其中4个随机对照试验(RCT),2个非随机的前瞻性对照试验,共867例PD病例,行PG手术患者440例,PJ手术患者426例.采用前瞻性研究(包括RCT)和单纯RCT分组进行荟萃分析:前瞻性对照试验组(包括RCT)荟萃分析中PG在术后并发症OR0.53,95％ CI(0.30,0.95),P=0.03]、胰瘘OR 0.47,95％ CI(0.22,0.97),P=0.04]、腹腔积液OR 0.42,95％CI(0.25,0.72),P=0.001],这3项指标中明显优于PJ,腹腔内并发症、病死率等指标上两种吻合方式差异未见统计学意义;RCT研究组荟萃分析中PG在术后腹腔积液OR 0.46,95％ CI(0.26,0.79),P=0.005]这项指标中明显优于PJ,在术后并发症、胰瘘、腹腔内并发症、病死率、胃排空延迟这些指标上两种吻合方式差异未见统计学意义.结论 前瞻性对照试验进行荟萃分析后可以发现PG在术后并发症、胰瘘、腹腔积液方面优于PJ.单纯对RCT进行荟萃分析后发现PG仅在术后腹腔积液方面优于PJ.表明PG在安全性上并不低于PJ.

Reconstruction of ancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy: a meta-analysis of prospectively controlled trials

Objective To compare the reconstructing safety of pancreaticogastrostomy (PG) versus pancreaticojejunostomy (PJ) after pancreaticoduodenectomy (PD).Methods The articles of prospectively controlled trials published until late December 2010 comparing PJ and PG after PD were searched by the means of MEDLINE,EMBASE,Cochrane Controlled Trials Register databases and Chinese Biomedical Database.After quality assessment of all included prospective controlled trials,a meta-analysis was performed with Review Manager 5.0 for statistic analysis.Results A total of 6 prospective controlled trials were included.Among 867 patients analyzed,440 underwent PG and 426 PJ.A meta-analysis of 6 prospective controlled trials (including randomized control trial (RCT) and non-randomized prospective trial) revealed significant differences between PJ and PG regarding the overall postoperative complication rates OR 0.53,95％ CI(0.30,0.95 ),P =0.03 ],pancreatic fistula OR 0.47,95％ CI(0.22,0.97 ),P =0.04 ] and intra-abdominal fluid collection OR 0.42,95％ CI ( 0.25,0.72 ),P =0.001 ].The differences in biliary fistula,intra-abdominal (IAC) complications and mortality were of no significance.Meta-analysis of 4 RCTs revealed significant differences between PJ and PG regarding intra-abdominal fluid collection OR 0.46,95％ CI (0.26,0.79 ),P =0.005 ].The differences in pancreatic fistula,overall postoperative complications,biliary fistula,intra-abdominal complications and mortality were of no statistical significance.Conclusion Through a meta-analysis of 6 prospective controlled trials,there are significant differences between PJ and PG regarding overall postoperative complications,pancreatic fistula and intraabdominal fluid collection.Significant differences exist between PJ and PG regarding intra-abdominal fluid collection.The safety profiles of PG and PJ are comparable.