高级搜索

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
shu
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
shu

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.

     

    • HTML全文
    • 参考文献(17)
  • [1] McKay A,Mackenzie S,Sutherland FR,et al．Meta-analysis of pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy[J]．Br J Surg,2006,93(8):929-36.
    [2] Butturini G,Daskalaki D,Molinari E,et al.Pancreatic fistuia：definition and current problems[J].J Hepatobiliary Pancreat Surg,2008,15(3):247-51.
    [3] Liu JP.The method of systematic review of non-randomized studys(1)[J].Zhongguo Xun Zheng Yi Xue,2001,1 (4):239-43. [刘建平.非随机研究的系统评价方法(一)[J] .中国循证医学,2001,1(4):239-43.]
    [4] Alexakis N,Halloran C,Raraty M,et al.Current standards of surgery for pancreatic cancer[J].Br J Surg,2004,91(11):1410-27.
    [5] Yeo CJ,Cameron JL,Maher MM,et al.A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy[J].Ann Surg,1995,222(4):580-8.
    [6] Arnaud JP,Tuech JJ,Cervi C,et al.Pancreaticogastrostomy compared with pancreaticojejunostomy after pancreaticoduodenectomy[J].Eur J Surg,1999,165(4):357-62.
    [7] Takano S,Ito Y,Watanabe Y,et al.Pancreaticojejunostomy versus pancreaticogastrostomy in reconstruction following pancreaticoduodenectomy[J].Br J Surg,2000,87(4):423-7.
    [8] Duffas JP,Suc B,Msika S,et al.A controlled randomized multicenter trial of pancreatogastrostomy or pancreatojejunostomy after pancreatoduodenectomy[J].Am J Surg,2005,189(6):720-9.
    [9] Bassi C,Falconi M,Molinari E,et al.Reconstruction by pancreaticojejunostomy versus pancreaticogastrostomy following pancreatectomy:results of a comparative study[J].Ann Surg,2005,242(6):767-71.
    [10] Fernández-Cruz L,Cosa R,Blanco L,et al.Pancreatogastrostomy with gastric partition after pylorus-preserving pancreatoduodenectomy versus conventional pancreatojejunostomy:a prospective randomized study [J].Ann Surg,2008,248(6):930-8.
    [11] Fang WL,Shyr YM,Su CH,et al.Comparison between pancreaticojejunostomy and pancreaticogastrostomy after pancreaticoduodenectomy[J].J Formos Med Assoc,2007,106(9):717-27.
    [12] Wellner U，Makowiec F，Fischer E，et al.Reduced postoperative pancreatic fistula rate after pancreatogastrostomy versus pancreaticojejunostomy[J].J Gastrointest Surg,2009,13(4):745-51.
    [13] Johnson CD,Howse F,Fitzsimmons D,et al.Quality of life after pancreatectomy[J].Ann Surg Oncol,2007,14 (2):750-1.
    [14] Murakami H,Suzuki H,Nakamura T.Pancreatic fibrosis correlates with delayed gastric emptying after pylorus- preserving pancreaticoduodenectomy with pancreaticogastrostomy[J].Ann Surg,2002,235(2):240-5.
    [15] Lermite E,Pessaux P,Brehant O,et al.Risk factors of pancreatic fistula and delayed gastric emptying after pancreaticoduodenectomy with pancreaticogastrostomy[J].J Am Coll Surg,2007,204(4):588-96.
    [16] Oida T,Mimatsu K,Kawasaki A,et al.Vertical stomach reconstruction with pancreaticogastrostomy after modified subtotal-stomach-preserving pancreaticoduodenectomy for preventing delayed gastric emptying[J].Hepatogastroenterology,2009,56(90):565-7.
    [17] Li HX.Controversies and appraisals about gastrointestinal reconstruction in pancreatoduodenectomy[J].She Jie Hua Ren Xiao Hua Za Zhi,2009,17(5):476-81.[李汉贤.胰十二指肠切除术消化道重建方法的争议和评价[J].世界华人消化杂志，2009,17(5):476-81.]
    • 相关文章
    • 施引文献
    • 资源附件(0)
计量
  • 文章访问数:  1954
  • HTML全文浏览量:  19
  • PDF下载量:  471
  • 被引次数: 0
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

目录

摘要
HTML全文
    参考文献(17)
    相关文章
    施引文献
    资源附件(0)

    /

    返回文章
    返回

    下载中心

    友情链接

    联系我们

    地址：武汉市洪山区卓刀泉南路116号（430079）

    电话：027－87670126

    Email：zlfzyjzz@vip.163.com

    This work is licensed under a Creative Commons Attribution 3.0 License.

    邮件订阅 RSS
    总访问量：12446703 今日访问：23926

    版权所有 © 《肿瘤防治研究》编辑部 鄂公网安备 42011102005013号 鄂ICP备2022015867号

    本系统由北京仁和汇智信息技术有限公司开发  百度统计

    x 关闭 永久关闭