胰十二指肠切除术后应用胰胃吻合与胰空肠吻合的Meta分析

目的 评价胰十二指肠切除术后胰胃吻合术与胰空肠吻合术的疗效.方法 计算机检索Cochrane Library（2014年第5期）、PubMed（1978年1月至2014年5月）、EMBASE（1966年1月至2014年5月）、SCI（1961年1月至2014年5月）、中国生物医学数据库（CBM）（1978年1月至2014年5月）、中国期刊全文数据库（CNKI）（1994年1月至2014年5月）,维普（1989年1月至2014年5月）和万方数据库（1998年1月至2014年5月）,同时在Google搜索引擎进行检索,并追查纳入研究参考文献,收集胰十二指肠切除术后胰胃吻合术与胰空肠吻合术的所有随机对照试验.根据Cochrane协作网推荐的“风险评估工具”进行偏倚风险评估,用RevMan5.2软件进行统计学分析.结果 纳入7项随机对照试验,共1 121例患者.Meta分析结果显示,与胰空肠吻合组相比,胰胃吻合组能降低胰十二指肠切除术后胰瘘发生率（RR=-0.56;95％ CI：0.41～0.75; P=-0.0001）、胆漏发生率（RR=0.43;95％ CI：0.19～ 0.95;P=-0.04）腹腔内多发并发症（OR=-0.26; 95％ CI：0.12 ～ 0.56;P=-0.0007）和腹腔内积液的发生（OR=-0.54;95％ CI：0.38～ 0.77;P=0.0005）,但两者在术后并发症、胃排空延迟、围手术期病死率方面差异均无统计学意义.结论 目前随机对照试验研究显示胰十二指肠切除术后消化道重建胰胃吻合术优于胰空肠吻合术.

Pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy: a Meta-analysis of randomized controlled trials

Objective To evaluate and compare the clinical effectiveness of pancreaticogastrostomy （PG） versus pancreaticojejunostomy （PJ） after pancreaticoduodenectomy （PD）.Methods The Cochrane Library （2014,5th issue）,PubMed （from Jan.1978 to May 2014）,EMBASE （from Jan.1966 to May 2014）,SCI （from Jan.1961 to May 2014）,Chinese Bio-medicine database （from Jan.1978 to May 2014）,Chinese Journal Full-text Database （from Jan.1994 to May 2014）,VIP database （from Jan.1989 to May 2014） and Wanfang database （from Jan.1998 to May 2014） were searched as well as websites of clinical trial registries and search engine Google were searched.Randomized controlled trials （RCTs） of pancreaticogastrostomy versus pancreaticojejunostomy following pancreaticoduodenectomy were included.The quality of included trials was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions Version.The Cochrane Collaboration＇s software RevMan 5.2 was used for Meta-analysis.Results Seven RCTs totaling 1 121 patients were included in this Meta-analysis,of which 562 patients undergone PG and 559 patients undergone PJ after PD.Meta-analysis of seven RCTs revealed significant difference between PG and PJ regarding pancreatic fistula （RR=0.56; 95％ CI：0.41 ～ 0.75; P=0.0001）,biliary fistula （RR=0.43; 95％ CI：0.19 ～ 0.95; P=0.04）,the morbidity of multiple intra-abdominal complications （OR=0.26; 95％ CI：0.12 ～ 0.56; P=0.0007） and intra-abdominal fluid collection （OR=0.54; 95％ CI：0.38 ～ 0.77; P=0.0005）.The differences in biliary fistula,overall postoperative complications,delayed gastric emptying and mortality were of no statistical significance.Conclusion Current RCTs suggest that PG is better than PJ for pancreatic reconstruction after PD.