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胰十二指肠切除术中胰管空肠黏膜吻合对比胰肠套入式吻合的Meta分析
作者:

吴传有1  罗涛1  龚建平2  李生伟2

Authors: Wu Chuanyou1, Luo Tao1, Gong Jianping2, Li Shengwei2
单位: 1重庆市渝北区中医院普通外科 401120;2重庆医科大学附属第二医院肝胆外科 400010
Units: 1Department of General Surgery, Chongqing Yubei District Hospital of Traditional Chinese Medicine, Chongqing 401120, China; 2Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
关键词: 外科手术;胰十二指肠切除术;胰肠吻合;胰管空肠黏膜吻合;胰肠套入式吻合; Meta分析
Keywords: Surgical procedures, operative;Pancreaticoduodenectomy;Pancreaticojejunostomy;Ducttomucosa;Invagination;Metaanalysis
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出版年,卷(期):页码:2020,47(1):23-27
摘要:

 目的  系统评价胰十二指肠切除术中胰管空肠黏膜吻合与胰肠套入式吻合的手术效果。方法  检索Cochrane Library、PubMed、EMbase、中国生物医学数据库等,查找关于胰十二指肠切除胰管空肠黏膜吻合与胰肠套入式吻合的随机对照试验,观察2种手术方式的术后胰瘘发病率,以及总的病死率、并发症发生率、胃排空障碍发病率、术后出血发生率、术后感染发病率、再手术率、住院天数。采用RevMan5.3软件进行Meta分析。结果  最终纳入9项随机对照试验,共1 163例患者,其中行胰管空肠黏膜吻合579例,行胰肠套入式吻合584例。Meta分析结果显示,胰管空肠黏膜吻合与胰肠套入式吻合在术后胰瘘发病率(RR=1.13,95%CI:0.88~1.45,P=0.34),以及总的病死率(RR=0.80,95%CI:0.42~1.52,P=0.49)、并发症发生率(RR=1.04,95%CI:0.88~1.24,P=0.63)、胃排空障碍发病率(RR=1.26,95%CI:0.90~1.76,P=0.18)、术后出血发生率(RR=0.86,95%CI:0.51~1.44,P=0.57)、术后感染发病率(RR=1.20,95%CI:0.86~1.69,P=0.29)、再手术率(RR=1.05,95%CI:0.62~1.78,P=0.84)、住院天数(WMD=-1.36,95%CI:-2.91~0.20,P=0.09),差异均无统计学意义。结论  胰十二指肠切除术中胰管空肠黏膜吻合与胰肠套入式吻合术后胰瘘发病率、总的病死率、并发症发生率、胃排空障碍发病率、术后出血发生率、术后感染发病率、再手术率、住院天数方面无明显差别。

Objective  To systematically evaluate the surgical effect  in duct-to-mucosa and invagination  groups of pancreaticojejunostomy  after pancreaticoduodenectomy. Methods  The Cochrane Library, PubMed, EMbase and CBM data bases were searched to identify randomized controlled trials that compared the postoperative pancreatic fistula, mortality,  incidence of complications, delayed gastric emptying, postoperative haemorrhage, infection, reoperate rate, postoperative hospital stay  of ducttomucosa and invagination for pancreaticcoduodenectomy. Metaanalysis was performed using the software RevMan 5.3. Results  Nine trials with 1 163 patients comparing the ducttomucosa group with invagination group were included, the ducttomucosa group with 579 patients and the invagination group with 584 patients. The metaanalysis revealed that, compared the ducttomucosa group with the invagination group, the rate of postoperative pancreatic fistula was not significantly reduced (RR=1.13, 95%CI: 0.881.45, P=0.34), there was no significant difference between the two group. To systematically evaluate the total mortality (RR=0.80, 95%CI: 0.421.52, P=0.49), incidence of complications (RR=1.04, 95%CI: 0.881.24, P=0.63), delayed gastric emptying (RR=1.26, 95%CI: 0.901.76, P=0.18), postoperative haemorrhage (RR=0.86, 95%CI: 0.511.44, P=0.57), postoperative infection (RR=1.20, 95%CI: 0.861.69, P=0.29), reoperate rate (RR=1.05, 95%CI: 0.621.78, P=0.84), postoperative hospital stay (WMD=-1.36, 95%CI:-2.91\|0.20, P=0.09) in ducttomucosa and invagination groups. There was no significant difference between the two group. Conclusions  There was no significant difference of postoperative pancreatic fistul and mortality, incidence of complications, delayed gastric emptying, postoperative haemorrhage, postoperative infection, reoperate rate, postoperative hospital stay in ducttomucosa and invagination groups of pancreaticojejunostomy  after pancreaticoduodenectomy.

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