胰十二指肠切除术后胰胃吻合和胰肠吻合临床疗效的Meta分析

发布时间：2018-05-26 21:49

本文选题：胰十二指肠切除术 + 胰胃吻合　；参考：《福建医科大学》2015年硕士论文

【摘要】：目的:评价胰十二指肠切除术后胰胃吻合与胰肠吻合的疗效。方法:通过计算机检索Pub Med、EMBASE、The Cochrane Library databases、中国生物医学数据库(CBM)、相关期刊论文(CNKI),收集所有比较胰十二指肠切除术后胰胃吻合术与胰肠吻合术疗效的随机对照试验,按照既定的纳入、排除标准,检出符合评价标准的文献,对纳入文献进行质量评估、证据水平评价、发表偏倚评价,并提取所需数据,采用Rev Man 5.2软件进行Meta分析。结果:纳入7篇随机对照试验(包含1121病人)。其中559例患者进行了胰肠吻合术,562例患者行胰胃吻合术。Meta分析结果显示:1.胰十二指肠切除术后胰胃吻合可以明显降低术后总胰瘘发生率(OR 1.70,95%CI:1.22-2.35,P=0.002)。在对高危组患者进行亚组分析后也得出了同样结论(OR 2.55,95%CI:1.30-5.01,P=0.006),该结果的证据级别为中级。2.胰胃吻合组患者术后腹腔内积液发生率明显低于胰肠吻合组(OR 2.33,95%CI:1.53-3.56,P0.0001)。3.胰胃吻合能明显减少患者住院天数(SMD 1.00,95%CI:0.34-1.65,P=0.003),但考虑存在较高的异质性(I2=90%),该结果的证据级别为极低级,并不可靠。4.两组在术后胃排空延迟发生方面未存在统计学差异(OR 1.02,95%CI:0.55-1.89,P=0.95)。但对采用同一定义的文章进行亚组分析结果则显示胰肠吻合在术后胃排空延迟方面存在优势(OR 0.60,95%CI:0.38-0.96,P=0.03),该结果的证据级别为中级。5.胰胃吻合组和胰肠吻合组在术后总并发症发生率上无显著性差异(OR 1.14,95%CI:0.84-1.57,P=0.40),考虑到这个结果同样存在明显异质性(I2=30%),在对异质性进行敏感性分析后我们发现,胰胃吻合方式的不同,术中是否使用胰腺导管支架,术中及术后是否使用生长抑素抑制剂是该异质性的重要来源。6.两组在术后出血,术后死亡率等并发症方面无明显差别。结论:基于这篇meta分析,胰十二指肠切除术后胰胃吻合能明显降低术后胰瘘及腹腔内积液的发生率,也能缩短住院时间,但存在增加术后胃排空延迟发生的风险。考虑到存在临床及方法学方面的异质性,我们期待有更高质量的随机对照试验验证我们的分析结果。
[Abstract]:Objective: to evaluate the curative effect of pancreaticogastric anastomosis and pancreaticojejunostomy after pancreaticoduodenectomy. Methods: the Pub Medmella Cochrane Library databases, Chinese biomedical database and the full text database of Chinese periodicals were searched by computer. All the randomized controlled trials were conducted to compare the effect of pancreaticoduodenectomy and pancreaticojejunostomy. According to the established inclusion and exclusion criteria, the documents which accord with the evaluation criteria were detected. The quality evaluation, the evidence level evaluation, the publication bias evaluation of the included documents were carried out, and the necessary data were extracted, and the Meta analysis was carried out with Rev Man 5.2 software. Results: seven randomized controlled trials (including 1121 patients) were included. 559 patients underwent pancreaticojejunostomy and 562 patients underwent pancreaticogastric anastomosis. After pancreaticoduodenectomy, pancreaticogastric anastomosis could significantly reduce the incidence of postoperative total pancreatic fistula (OR 1.7095 CI: 1.22-2.35% P0. 002). After subgroup analysis of patients in high-risk group, the same conclusion was obtained, or 2.55 ~ 95% CI: 1.30-5.01% P0. 006, the evidence level of this result was intermediate. 2. The incidence of intraperitoneal effusion in the pancreaticogastric anastomosis group was significantly lower than that in the pancreaticojejunostomy group. Pancreaticogastric anastomosis could significantly reduce the days of hospitalization of patients with SMD 1.00 ~ 95% CI: 0.34-1.65Ph 0.003, but considering the existence of higher heterogeneity, the evidence level of this result was very low and unreliable. There was no significant difference in the occurrence of delayed gastric emptying between the two groups. However, the results of subgroup analysis with the same definition showed that there was an advantage in gastric emptying delay after pancreaticojejunostomy. There was no significant difference in the incidence of postoperative complications between the pancreaticogastric anastomosis group and the pancreaticojejunostomy group. The important source of this heterogeneity is whether the pancreatic stent is used during the operation and whether the somatostatin inhibitor is used during or after the operation. There was no significant difference in postoperative bleeding, postoperative mortality and other complications between the two groups. Conclusion: based on this meta analysis, pancreaticogastric anastomosis after pancreaticoduodenectomy can significantly reduce the incidence of postoperative pancreatic fistula and intraperitoneal effusion, and shorten the hospitalization time, but there is a risk of delayed gastric emptying after pancreaticoduodenectomy. In view of the clinical and methodological heterogeneity, we look forward to a higher quality randomized controlled trial to validate our results.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.5

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