Reconstruction methods of digestive tract after pancreaticodudenectomy：a systematic review and meta-analysis of RCTs
10.3760/cma.j.issn.1671-0274.2014.10.012
- VernacularTitle:基于临床随机对照试验的胰十二指肠切除术后消化道重建方式的系统评价
- Author:
Purun LEI
1
;
Bo WEI
;
Jiafeng FANG
;
Jianpei LIU
;
Guangsheng OU
;
Lijun HUANG
;
Hongbo WEI
Author Information
1. 中山大学附属第三医院胃肠外科
- Keywords:
Pancreaticodudenectomy;
Pancreatogastrostomy;
Pancreaticojejunostomy;
Reconstruction;
Stent;
Pancreatic fistula;
Meta-analysis
- From:
Chinese Journal of Gastrointestinal Surgery
2014;(10):1002-1008
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate different types of anastomosis and reconstruction techniques after pancreaticodudenectomy with meat-analysis. Methods Systematically literature search was performed through Wanfang, PubMed, EMBASE, Web of Science and Cochrane Library database without restriction to regions, publication types, or languages. A total of 17 randomized controlled trials met the criteria and were evaluated by Jadad scale. Fixed and random-effects models were used to measure the pooled estimates, including pancreatic fistula, bile leakage, hemorrhage, delay gastric emptying (DGE), mortality, reoperation. Results Meta analysis revealed that patients undergoing pancreaticogastrostomy had a lower incidence of pancreatic fistula and bile leakage (OR=0.60,95% CI:0.44-0.82,P=0.001; OR=0.33,95% CI:0.13-0.82,P=0.02) as compared to pancreaticojejunostomy. In pancreaticoenterostomy group, pancreatic duct-mucosa pancreaticoenterostomy had no significant differences with traditional end-to-end anastomosis in terms of overall postoperative morbidity, and development of postoperative pancreatic fistula, reoperation, perioperative death. External stent placement drainage group had a lower postoperative overall complication rate and incidence of pancreatic fistula, especially the Ⅱ-Ⅲ grade pancreatic fistula, and a shorter hospital stay than non-stent drainage group (all P<0.05). Conclusions Pancreaticogastrostomy should be recommended as digestive tract reconstruction after pancreaticodudenectomy and assistant external stent drainage is also necessary.
