目的 系统评价胰十二指肠切除术中,胰管支撑外引流与非引流术后胰瘘的发病率、总的并发症发病率、病死率以及住院天数.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术中,胰管支撑外引流与非引流的随机对照试验,采用RevMan5.2软件进行Meta分析.结果 纳入4个随机对照试验,总共416例患者,术中行胰管支撑外引流的患者207例,未行胰管支撑引流的患者209例.Meta分析结果显示:胰十二指肠切除术中行胰管支撑外引流与未行胰管支撑引流相比,行胰管支撑外引流能够显著降低胰十二指肠切除术后胰瘘的发病率[RR =0.57,95％ CI(0.41,0.80),P=0.001],尤其是胰管直径≤3.0 mm者的术后胰瘘的发病率[RR =0.55,95％ CI(0.37,0.82),P=0.003]和质地较软胰腺者的术后胰瘘的发病率[RR =0.67,95％ CI(0.45,0.99),P=0.040],降低术后并发症的发病率[RR =0.79,95％ CI(0.64,0.98),P=0.030],缩短住院天数[WMD=-3.98,95％ CI(-6.42,-1.54),P=0.001];两组在胰管直径＞3.0 mm者的术后胰瘘的发病率[RR =0.37,95％ CI(0.08,1.83),P=0.220],以及总的术后病死率[RR =0.86,95％ CI(0.28,2.65),P=0.800]上差异无统计学意义.结论 胰十二指肠切除术中,行胰管支撑外引流能减少术后胰瘘的发病率,降低术后并发症的发生,缩短住院天数,值得在临床上推广应用.
目的 繫統評價胰十二指腸切除術中,胰管支撐外引流與非引流術後胰瘺的髮病率、總的併髮癥髮病率、病死率以及住院天數.方法 檢索Cochrane Library、PubMed、Embase、中國生物醫學數據庫等,查找關于胰十二指腸切除術中,胰管支撐外引流與非引流的隨機對照試驗,採用RevMan5.2軟件進行Meta分析.結果 納入4箇隨機對照試驗,總共416例患者,術中行胰管支撐外引流的患者207例,未行胰管支撐引流的患者209例.Meta分析結果顯示:胰十二指腸切除術中行胰管支撐外引流與未行胰管支撐引流相比,行胰管支撐外引流能夠顯著降低胰十二指腸切除術後胰瘺的髮病率[RR =0.57,95％ CI(0.41,0.80),P=0.001],尤其是胰管直徑≤3.0 mm者的術後胰瘺的髮病率[RR =0.55,95％ CI(0.37,0.82),P=0.003]和質地較軟胰腺者的術後胰瘺的髮病率[RR =0.67,95％ CI(0.45,0.99),P=0.040],降低術後併髮癥的髮病率[RR =0.79,95％ CI(0.64,0.98),P=0.030],縮短住院天數[WMD=-3.98,95％ CI(-6.42,-1.54),P=0.001];兩組在胰管直徑＞3.0 mm者的術後胰瘺的髮病率[RR =0.37,95％ CI(0.08,1.83),P=0.220],以及總的術後病死率[RR =0.86,95％ CI(0.28,2.65),P=0.800]上差異無統計學意義.結論 胰十二指腸切除術中,行胰管支撐外引流能減少術後胰瘺的髮病率,降低術後併髮癥的髮生,縮短住院天數,值得在臨床上推廣應用.
목적 계통평개이십이지장절제술중,이관지탱외인류여비인류술후이루적발병솔、총적병발증발병솔、병사솔이급주원천수.방법 검색Cochrane Library、PubMed、Embase、중국생물의학수거고등,사조관우이십이지장절제술중,이관지탱외인류여비인류적수궤대조시험,채용RevMan5.2연건진행Meta분석.결과 납입4개수궤대조시험,총공416례환자,술중행이관지탱외인류적환자207례,미행이관지탱인류적환자209례.Meta분석결과현시:이십이지장절제술중행이관지탱외인류여미행이관지탱인류상비,행이관지탱외인류능구현저강저이십이지장절제술후이루적발병솔[RR =0.57,95％ CI(0.41,0.80),P=0.001],우기시이관직경≤3.0 mm자적술후이루적발병솔[RR =0.55,95％ CI(0.37,0.82),P=0.003]화질지교연이선자적술후이루적발병솔[RR =0.67,95％ CI(0.45,0.99),P=0.040],강저술후병발증적발병솔[RR =0.79,95％ CI(0.64,0.98),P=0.030],축단주원천수[WMD=-3.98,95％ CI(-6.42,-1.54),P=0.001];량조재이관직경＞3.0 mm자적술후이루적발병솔[RR =0.37,95％ CI(0.08,1.83),P=0.220],이급총적술후병사솔[RR =0.86,95％ CI(0.28,2.65),P=0.800]상차이무통계학의의.결론 이십이지장절제술중,행이관지탱외인류능감소술후이루적발병솔,강저술후병발증적발생,축단주원천수,치득재림상상추엄응용.
Objective To systematically evaluate the postoperative pancreatic fistula rate,overall postoperative morbidity rate,overall postoperative mortality rate and length of stay in external stent group versus no stent group for pancreaticcoduodenectomy.Methods The Cochrane Library,PubMed,Embase and CBM data bases were searched to identify randomized controlled trials that compared the effectiveness of external stent versus no stent for pancreaticcoduodenectany.Meta-analysis was performed using the software RevMan 5.2.Results Four trials with 416 patients comparing external stent with no stent were included,the external stent group with 207 patients and the no stent group with 209 patients.The Meta-analysis revealed that,compared the external stent group with the no stent group,the rate of postoperative pancreatic fistula was significantly reduced in the external stent group [RR =0.57,95％ CI(0.41,0.80),P =0.001],especially for the patinets of pancreatic diameter ≤ 3.0 mm[RR =0.55,95 ％ CI(0.37,0.82),P =0.003] and soft pancreatic [RR =0.67,95 ％ CI(0.45,0.99),P =0.040],the overall postoperative morbidity rate of external stent group versus.no stent group was reduced[RR =0.79,95 ％ CI (0.64,0.98),P =0.030],and length of stay was shortened [WMD =-3.98,95％ CI(-6.42,-1.54),P =0.001].There was no difference between the two groups regarding the postoperative pancreatic fistula rate of diameter ＞ 3.0 mm [RR =0.37,95 ％ CI(0.08,1.83),P =0.220],and the overall postoperative mortality rate [RR =0.86,95 ％ CI(0.28,2.65),P =0.800].Conclusions Exental stent significantly reduced the postoperative pancreatic fistula rate and overall postoperative morbidity rate 、shortened the length of stay,and thus it can be identified as a preferable option for Pancreaticcoduodenectomy.
