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胰肠吻合和胰胃吻合在胰十二指肠切除术后临床疗效的Meta分析

钟敬涛, 石学涛

钟敬涛, 石学涛. 胰肠吻合和胰胃吻合在胰十二指肠切除术后临床疗效的Meta分析[J]. 肿瘤防治研究, 2012, 39(12): 1474-1478. DOI: 10.3971/j.issn.1000-8578.2012.12.016
引用本文: 钟敬涛, 石学涛. 胰肠吻合和胰胃吻合在胰十二指肠切除术后临床疗效的Meta分析[J]. 肿瘤防治研究, 2012, 39(12): 1474-1478. DOI: 10.3971/j.issn.1000-8578.2012.12.016
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Zhong Jingtao, Shi Xuetao. Comparison between Pancreaticojejunostomy with Pancreaticogastrostomy after Panereatieoduodenectomy：A Meta Analysis[J]. Cancer Research on Prevention and Treatment, 2012, 39(12): 1474-1478. DOI: 10.3971/j.issn.1000-8578.2012.12.016
Citation: Zhong Jingtao, Shi Xuetao. Comparison between Pancreaticojejunostomy with Pancreaticogastrostomy after Panereatieoduodenectomy：A Meta Analysis[J]. Cancer Research on Prevention and Treatment, 2012, 39(12): 1474-1478. DOI: 10.3971/j.issn.1000-8578.2012.12.016
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胰肠吻合和胰胃吻合在胰十二指肠切除术后临床疗效的Meta分析

  • 250117济南，山东省肿瘤医院肝胆外科

详细信息
    作者简介:

    钟敬涛（1987-），男，硕士，主要从事肝胆胰肿瘤的基础与临床研究

    通讯作者:

    石学涛，E-mail：shixuetao9@yahoo.com.cn

  • 中图分类号: R6；R735

Comparison between Pancreaticojejunostomy with Pancreaticogastrostomy after Panereatieoduodenectomy：A Meta Analysis

  • Liver and Gallbladder Surgery,Shandong Province Tumor Hospital,Ji′nan 250117,China

摘要

    摘要
  • 摘要: 目的 以循证医学证据评价胰肠吻合(pancreaticojejunostomy,PJ)和胰胃吻合(pancreaticogastrostomy,PG)在胰十二指肠切除术(panereatieoduodenectomy,PD)后的临床疗效。方法通过计算机检索PubMed数据库、EMBASE、万方数据库、中国全文期刊数据库和维普数据库，并结合文献追溯的方法，收集关于胰肠吻合和胰胃吻合在胰十二指肠切除术后临床疗效的随机前瞻性对照试验（RCT)或非随机前瞻性对照试验（NRCT），并按 Cochrane协作网推荐的方法对符合纳入标准的 6个研究共866例患者进行Meta分析,发表偏倚用漏斗图评估。结果Meta分析结果显示，与胰肠吻合组相比，胰胃吻合组能降低胰十二指肠切除术后胰瘘发生率（P=0.003）、术后并发症的发生率（P=0.04）和腹腔内积液的发生（P=0.01），但两者在术后胆瘘发生率（P=0.08）和围手术期死亡率（P=0.14)方面差异均无统计学意义。结论在胰十二指肠切除术后胰瘘、术后并发症发生率及腹腔内积液等方面，PG优于PJ，但是两者在胆瘘及围手术期死亡率等方面，疗效相当。且纳入的研究存在选择偏倚、发表偏倚及测量偏倚的可能性，这势必会影响结果的论证强度，所以进一步结论需要更多高质量的随机对照试验来进一步探讨、论证。

     

    Abstract: Objective To evaluate the clinical effects of Pancreaticojejunostomy(PJ) and pancreaticogastrostomy(PG) after panereatieoduodenectomy(PD) by evidence based medicine. Methods Clinical data(RCT or NRCT)of effects after panereatieoduodenectomy underwent pancreaticojejunostomy or pancreaticogastrostomy were collected from computer literature searching,which was carried out in PubMed,EMBASE,Wanfang and VIP database etc.Meta analysis recommended by Cochrane Collaboration was done for the data obtained that 866 patients who met with the six criteria of enrollment were included in this study.Publication bias was assessed by using a funnel plot. Results The results of Meta-analysis show that the pancreatic fistula（P=0.003）,complication rate（P=0.04）and intra-abdominal fluid collection(P=0.01)was lower in patients treated with pancreaticogastrostomy than in those treated with pancreaticojejunostomy.However,compared with pancreaticojejunostomy,there was no significantly statistical difference in the incidence of Bile leak(P=0.08),and perioperative mortality(P=0.14). Conclusion The results show that pancreaticogastrostomy after panereatieoduodenectomy can reduce the incidence of pancreatic fistula,complication rate and intra-abdominal fluid collection in a certain degree.But it can not effectively prevent the occurrence of Bile leak and perioperative mortality.Further more,because these RCTs and NRCTs included may have selection bias,publication bias and measurement bias which can strength strongly affect the outcome of the argument,so the further conclusion need more high-quality RCTs to deeply explore and demonstrate.

     

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    • 参考文献(17)
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出版历程
  • 收稿日期:  2012-02-01
  • 修回日期:  2012-06-04
  • 刊出日期:  2012-12-24

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