文章摘要
雷海鸣,侍杏华,韩扣兰,史卫红.应用胰管外支架对术后胰瘘影响的Meta分析[J].南京医科大学学报,2016,(10):1277~1282
应用胰管外支架对术后胰瘘影响的Meta分析
Meta-analysis of the effect of pancreatic external stent on postoperative pancreatic fistula
投稿时间:2016-02-23  
DOI:10.7655/NYDXBNS20161029
中文关键词: 支架  引流  胰十二指肠切除术  胰瘘  Meta分析
英文关键词: stent  drainage  pancreaticoduodenectomy  pancreatic fistula  meta-analysis
基金项目:
作者单位
雷海鸣 盐城卫生职业技术学院临床医学院,江苏 盐城 224005 
侍杏华 盐城卫生职业技术学院临床医学院,江苏 盐城 224005 
韩扣兰 盐城卫生职业技术学院临床医学院,江苏 盐城 224005 
史卫红 盐城卫生职业技术学院临床医学院,江苏 盐城 224005 
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中文摘要:
      目的:评价在胰十二指肠切除术中使用胰管外支架对术后胰瘘发生的影响。方法:检索万方?中国知网?Sinomed中文数据库和PubMed?Web of Science?CochraneCentral Register of Controlled Trials外文数据库,筛选有关胰管外支架放置与否的临床随机对照研究为纳入文献,选择危险比(risk ratio,RR)及95%的可信区间(confidenceintervals,CI)为合并效应量,对提取数据进行Meta分析。结果:共有6篇文献符合纳入标准,其中胰管外支架组280例,无支架组281例。Meta分析结果显示两组在胰瘘率(RR = 0.54,95%CI:0.39 ~ 0.74),特别是在B?C级胰瘘(RR = 0.55,95%CI:0.37 ~ 0.82)及胰管无扩张的胰瘘(RR = 0.50,95%CI:0.34 ~ 0.73)上的差异具有统计学意义(P < 0.05)。同时两组在术后总并发症率和住院时间上的差异亦具有统计学意义(P < 0.05)。然而,两组在病死率?腹腔脓肿?腹腔出血?胃排空减慢?输血?二次手术?手术时间?术中失血量上的差异均无统计学意义(P > 0.05)。结论:应用胰管外支架可以有效减少术后胰瘘的发生,并且有利于术后病程的改善。该法安全可行,值得临床推广应用。
英文摘要:
      Objective:To evaluate the effect of pancreatic external stent used in pancreaticoduodenectomy on postoperative pancreatic fistula. Methods:Literature search was conducted in Chinese electronic database including Wanfang Database,CNKI and Chinese Biological Medicine Database,and English electronic database including PubMed,Web of Science and Cochrane Central Register of Controlled Trials. Clinical randomized controlled trials regarding the comparison of external stent and no stent were selected for inclusion. Risk ratio (RR) with the corresponding 95% confidence interval (CI) was used for overall effect estimation. Data were extracted for meta-analysis. Results:Overall,six studies met the inclusion criteria with 280 patients in the external stent group and 281 in the no stent group. Meta-analysis showed that there was a significant difference between two groups in pancreatic fistula rate(RR = 0.54,95% CI = 0.39 ~ 0.74),especially in subgroups of grade B and C (RR = 0.55,95% CI = 0.37 ~ 0.82),and non-dilated pancreatic duct (RR = 0.50,95% CI = 0.34 ~ 0.73)(P < 0.05). Meanwhile,the differences between two groups in postoperative morbidity and hospital stay were also statistically significant (P < 0.05). However,no significant differences in mortality,abdominal abscess,hemorrhage,delayed gastricemptying,blood replacement,reoperation,operation time and operative blood loss were found between two groups (P > 0.05). Conclusion:Using pancreatic external stent could effectively reduce the incidence of postoperative pancreatic fistula,and improve postoperative course. The method is safe,feasible,and worthy of popularization and application clinically.
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