CAJ | 학술논문

目的评价不同胰肠吻合方式对胰十二指肠切除术后胰漏发生率的影响.方法通过计算机检索PubMed数据库、EMBase数据库、COCHRANE Library、中国期刊全文数据库、万方数据库及维普中文科技期刊数据库,并结合文献追溯的方法,收集2013年9月以前发表的关于胰肠吻合在胰十二指肠切除术后临床疗效的前瞻性随机对照试验和前瞻性非随机对照试验.对符合纳入条件的文献运用Review Manager 5.0软件进行统计分析.结果共有8篇文献符合纳入标准,其中5篇关于套入式胰肠吻合与胰管对黏膜端侧胰肠吻合临床疗效的文献.研究结果显示,二者对术后胰漏发生率(M-H法:OR =0.77,95％ CI:0.35 ～ 1.69,P=0.52)、再手术率(M-H法:OR=1.38,95％ CI:0.64 ～2.95,P=0.41)及围手术期死亡率(M-H法:OR=1.15,95％ CI:0.42～3.13,P=0.79)的影响无统计学意义;3篇关于捆绑式胰肠吻合与常规胰肠吻合(包括套入式胰肠吻合与胰管对黏膜端侧胰肠吻合)临床疗效比较的文献,研究结果显示,捆绑式胰肠吻合与常规胰肠吻合对术后胰漏发生率(M-H法:OR =0.57,95％ CI =0.28 ～ 1.17,P=0.13)、再手术率(M-H法:OR=1.18,95％ CI=0.48～2.92,P=0.72)及围手术期死亡率(M-H法:OR=0.74,95％CI=0.27 ～ 1.99,P=0.55)的影响无统计学意义.结论胰十二指肠切除术捆绑式胰肠吻合与常规胰肠吻合、胰管对黏膜端侧吻合与套入式胰肠吻合对术后胰漏的发生率、再手术率及围手术期死亡率的影响无差异.
목적 평개불동이장문합방식대이십이지장절제술후이루발생솔적영향.방법 통과계산궤검색PubMed수거고、EMBase수거고、COCHRANE Library、중국기간전문수거고、만방수거고급유보중문과기기간수거고,병결합문헌추소적방법,수집2013년9월이전발표적관우이장문합재이십이지장절제술후림상료효적전첨성수궤대조시험화전첨성비수궤대조시험.대부합납입조건적문헌운용Review Manager 5.0연건진행통계분석.결과 공유8편문헌부합납입표준,기중5편관우투입식이장문합여이관대점막단측이장문합림상료효적문헌.연구결과현시,이자대술후이루발생솔(M-H법:OR =0.77,95％ CI:0.35 ～ 1.69,P=0.52)、재수술솔(M-H법:OR=1.38,95％ CI:0.64 ～2.95,P=0.41)급위수술기사망솔(M-H법:OR=1.15,95％ CI:0.42～3.13,P=0.79)적영향무통계학의의;3편관우곤방식이장문합여상규이장문합(포괄투입식이장문합여이관대점막단측이장문합)림상료효비교적문헌,연구결과현시,곤방식이장문합여상규이장문합대술후이루발생솔(M-H법:OR =0.57,95％ CI =0.28 ～ 1.17,P=0.13)、재수술솔(M-H법:OR=1.18,95％ CI=0.48～2.92,P=0.72)급위수술기사망솔(M-H법:OR=0.74,95％CI=0.27 ～ 1.99,P=0.55)적영향무통계학의의.결론 이십이지장절제술곤방식이장문합여상규이장문합、이관대점막단측문합여투입식이장문합대술후이루적발생솔、재수술솔급위수술기사망솔적영향무차이.
Objective To evaluate the pancreatic fistula affected by different type of pancreaticojejunostomy after pancreaticoduodenectomy.Methods Electronic databases PubMed,EMBase,COCHRANE Library,Wanfang,and VIP etc were used to search for randomized controlled trials or non randomized prospective controlled trials reported before September 2013 on clinical effects of pancreaticojejunostomy after pancreaticoduodenectomy.The statistical analysis was done by Review Manager 5.0.Results A total of 8 trials were included in this meta-analysis.The effects of duct-to-mucosa pancreaticojejunostomy (dmPJ) and invaginating pancreaticojejunostomy (iPJ) on postoperative complication in five studies were compared,and no statistical significance were found in postoperative pancreatic fistula (POPF) (M-H:OR =0.77,95％ CI:0.35-1.69,P =0.52),reoperation (M-H:OR =1.38,95％ CI:0.64-2.95,P =0.41) and mortality (M-H:OR =1.15,95 ％ CI:0.42-3.13,P =0.79) between dmPJ and iPJ.The effects of binding pancreaticojejunostomy (bPJ) and conventional pancreaticojejunostomy (cPJ) (including duct-to-mucosa pancreaticojejunostomy and invaginating pancreaticojejunostomy) on postoperative complication were compared,and no statistical significance were found in postoperative pancreatic fistula (POPF)(M-H:OR=0.57,95％ CI =0.28-1.17,P =0.13),reoperation(M-H:OR =1.18,95％ CI =0.48-2.92,P =0.72) and mortality (M-H:OR =0.74,95％ CI =0.27-1.99,P =0.55) between bPJ and cPJ.Conclusion There are no significant differences between dmPJ and iPJ in pancreatic fistula reoperation and mortality,and there are also no significant differences between bPJ and cPJ.