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Impact of internal and external drainage of the pancreatic duct on pancreatic fistula after pancreaticoduodenectomy:A meta-analysis

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Author:: No author available

Journal Title:: World Chinese Journal of Digestology

Issue:: 23

DOI:: 10.11569/wcjd.v29.i23.1341

Key Word:: 胰十二指肠切除术;支撑管;内引流;外引流

Abstract：背景本研究结合国内外关于胰十二指肠切除术(pancreaticoduodenectomy,PD)胰管支撑管内外引流研究的基础上,对其术后胰瘘的发生率进行Meta分析,进而为从事胰腺手术的临床工作者术中内衬管方式的选择提供循证医学的支持.目的系统评价胰管支撑管内外引流对PD后胰瘘的影响.方法计算机检索PubMed、Embase、Cochrane、中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方期刊论文数据库、维普期刊数据库,搜索2016年以后PD行内、外引流的随机对照及回顾性研究,对符合纳入标准的临床研究提取相关资料,随机对照研究采用Cochrane风险偏倚评估工具进行质量评价,回顾性研究采用纽卡斯尔-渥太华量表(Newcast-Ottawa scale,NOS)进行质量评价,采用RevMan 5.3统计软件进行Meta分析.结果共纳入4篇回顾性研究,合计1213例患者.Meta分析显示胰管内外引流对术后临床相关胰瘘的改善无差异[OR=1.42,95％CI(0.84,2.40),P=0.19],敏感性分析排除异质性较大的研究后,各研究之间可认为不存在异质性(P=0.33,I2=8.7％),采用固定效应模型合并效应量后差异有统计学意义[OR=1.83,95％CI(1.12,2.99),P=0.02],外引流能降低术后临床相关胰瘘的发生率.亚组分析显示,胰管支撑管内外引流对B级胰瘘[OR=0.95,95％CI(0.64,1.40),P=0.78]、C级胰瘘[OR=1.58,95％CI(0.81,3.09),P=0.18]的改善并无统计学差异.结论胰管支撑管外引流能降低术后临床相关胰瘘的发生率,但对B级和C级胰瘘的改善尚无统计学差异,需要进一步研究进行验证.

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