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大网膜包裹胰肠吻合口预防胰十二指肠切除术后并发症有效性和安全性的Meta分析

史亚波 李扬 刘华兵 王智聪 黄长文

引用本文:
Citation:

大网膜包裹胰肠吻合口预防胰十二指肠切除术后并发症有效性和安全性的Meta分析

DOI: 10.12449/JCH240122
基金项目: 

江西省自然科学基金面上项目 (20202BABL206096)

利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:史亚波、黄长文负责课题设计,资料分析,撰写论文;李扬、刘华兵、王智聪参与收集数据,修改论文;黄长文负责拟定写作思路,指导撰写文章并最后定稿。
详细信息
    通信作者:

    黄长文, ncdxhcw@163.com (ORCID: 0000-0001-6898-0162)

Efficacy and safety of omental wrapping technique for pancreaticojejunal anastomosis in preventing complications after pancreaticoduodenectomy: A Meta-analysis

Research funding: 

General Program of National Natural Science Foundation of Jiangxi Province (20202BABL206096)

More Information
    Corresponding author: HUANG Changwen, ncdxhcw@163.com (ORCID: 0000-0001-6898-0162)
  • 摘要:   目的  系统评价大网膜包裹胰肠吻合口预防胰十二指肠切除术后并发症的有效性和安全性。  方法  本研究根据PRISMA指南完成。计算机检索中国知网、万方、维普、中国生物医学文献数据库、Cochrane Library、PubMed、Embase和Web of Science等中英文数据库,从数据库建立至2022年11月有关大网膜包裹胰肠吻合口预防胰十二指肠切除术后并发症的临床研究,采用Stata 16和Review Manager 5.4进行Meta分析。  结果  纳入15项研究,共1 830例患者。Meta分析结果显示:网膜包裹组术后胰瘘总体发生率较非网膜包裹组更低(OR=0.30,95%CI:0.22~0.41,P<0.001),亚组分析提示网膜包裹组B/C级术后胰瘘发生率较非网膜包裹组更低(OR=0.29,95%CI:0.21~0.39,P<0.001)。网膜包裹组相较于非网膜包裹组,术后胆漏(OR=0.30,95%CI:0.16~0.56,P<0.001)、术后出血(OR=0.35,95%CI:0.24~0.53,P<0.001)、胃排空障碍(OR=0.45,95%CI:0.31~0.64,P<0.001)、腹腔感染(OR=0.55,95%CI:0.40~0.75,P<0.001)、再次手术(OR=0.31,95%CI:0.18~0.54,P<0.001)、术后30天死亡(OR=0.42,95%CI:0.22~0.80,P=0.009)的发生率更低,开放饮食时间更早(MD=-0.98,95%CI:-1.84~-0.11,P=0.03)、术后住院时间更短(MD=-2.44,95%CI:-4.10~-0.77,P=0.004),两组手术方式在手术时间(MD=-13.68,95%CI:-28.31~0.95,P=0.07)及术中出血量(MD=-17.26,95%CI:-57.55~23.03,P=0.40)方面差异无统计学意义。  结论  网膜包裹可降低术后胰瘘、胆漏、出血、腹腔感染、胃排空障碍等术后并发症的发生率,改善患者预后,缩短住院时间,且不增加手术难度及手术时间。

     

  • 图  1  筛选流程图

    Figure  1.  Screening flow chart

    图  2  POPF发生率的Meta分析结果

    Figure  2.  Meta-analysis result of postoperative pancreatic fistula

    图  3  术后胆漏的Meta分析结果

    Figure  3.  Meta-analysis result of postoperative biliary leakage

    图  4  术后PPH的Meta分析结果

    Figure  4.  Meta-analysis result of postpancreatectomy hemorrhages

    图  5  术后DGE的Meta分析结果

    Figure  5.  Meta-analysis result of postoperative gastric emptying disorder

    图  6  术后腹腔感染的Meta分析结果

    Figure  6.  Meta-analysis result of postoperative abdominal infection

    图  7  再次手术的Meta分析结果

    Figure  7.  Meta-analysis result of reoperation

    图  8  术后30天病死率的Meta分析结果

    Figure  8.  Meta-analysis result of 30-day postoperative mortality

    图  9  术后住院时间的Meta分析结果

    Figure  9.  Meta-analysis result of postoperative hospital stay

    图  10  术后开放饮食时间的Meta分析结果

    Figure  10.  Meta-analysis result of postoperative open diet time

    图  11  手术时间的Meta分析结果

    Figure  11.  Meta-analysis result of operation time

    图  12  术中出血量的Meta分析结果

    Figure  12.  Meta-analysis result of intraoperative blood loss

    图  13  敏感性分析结果

    注: a,术后住院时间;b,开放饮食时间;c,手术时间;d,术中出血量。

    Figure  13.  Sensitivity analysis results

    图  14  漏斗图

    注: a, POPF;b, 术后PPH;c, 术后腹腔感染;d, 术后DGE;e, 再次手术;f, 术后30天死亡;g, 术后住院时间;h, 手术时间。

    Figure  14.  Funnel plot

    表  1  纳入研究的基线资料

    Table  1.   Baseline data included in the study

    作者 发表时间 研究类型 国家 研究周期 组别 年龄(岁) 男/女(例) 例数 BMI (kg/m2 结局指标
    Shah11 2015 RCS 印度 2006—2012 T C 61.5 60.2 59/42 27/19 101 46 21.5 20.6 ①②③④⑤⑥⑦⑧⑩⑪
    Tangtawee12 2021 RCT 泰国 2017—2019 T C 62.0 58.2 17/17 16/18 34 34 22.7 23.2 ①③④⑤⑦⑧⑩⑪
    Choi13 2012 RCS 韩国 2009—2011 T C 63.9 63.9 19/10 25/14 29 39 23.6 23.6 ①③
    Deng14 2022 RCS 中国 2015—2020 T C 60.6 57.6 49/37 60/29 86 89 23.0 23.1 ①②③④⑤⑥⑧⑨⑩
    Kapoor15 2006 RCS 印度 2002—2006 T C NA NA NA/NA NA/NA 25 52 NA NA ①③⑦
    Zhong16 2018 RCS 中国 2005—2016 T C 59.8 57.8 31/34 31/30 65 61 22.6 22.1 ①②③④⑤⑥⑦⑧⑩⑪
    Li17 2022 RCS 中国 2015—2019 T C 64.2 62.1 46/23 44/25 69 69 21.9 22.0 ①②③④⑤⑥⑦⑨⑩
    刘蕾18 2022 RCS 中国 2017—2020 T C 64.3 59.1 17/18 20/23 35 43 NA NA ①③④⑤⑥⑦⑧
    孙韶龙19 2016 RCT 中国 2013—2015 T C 65 63 13/5 11/7 35 35 NA NA
    孟思嘉20 2022 RCS 中国 2015—2021 T C 61.0 61.3 102/69 71/56 171 127 NA NA ①②③④⑤⑥⑦⑧⑩⑪
    杜刚21 2018 RCS 中国 2012—2017 T C 53.3 52.8 33/30 34/29 63 63 NA NA ①③④⑤⑥⑩⑪
    王宏伟22 2022 RCS 中国 2018—2021 T C 64.6 62.8 22/16 11/8 38 19 21.8 20.8 ①③④⑤⑥⑦⑧⑨⑩
    许洁如23 2016 RCS 中国 2009—2015 T C 56.3 56.8 38/26 41/43 64 64 NA NA ①③④⑤⑥⑦⑩⑪
    邓尧24 2020 RCS 中国 2015—2018 T C 64.8 62.1 79/48 44/25 127 69 21.9 22.0 ①②③④⑤⑥⑦⑧⑨
    邝乃乐25 2022 RCS 中国 2018—2020 T C 59.6 62.6 22/16 19/21 38 40 NA NA ①②③④⑥⑧⑩⑪
    注:T,网膜包裹组;C,非网膜包裹组。结局指标:①POPF;②胆漏;③PPH;④DGE;⑤腹腔感染;⑥再手术;⑦术后30天内病死率;⑧术后住院时间;⑨开放饮食时间;⑩手术时间;⑪术中出血量;NA,未提供。
    下载: 导出CSV

    表  2  纳入RCS的质量评价

    Table  2.   Quality evaluation of the included RCS

    作者 人群选择(分) 组间可比性(分) 暴露因素(分) 合计(分)
    Shah11 3 2 2 7
    Choi13 3 1 2 6
    Deng14 3 2 2 7
    Kapoor15 3 1 2 6
    Zhong16 3 2 2 7
    Li17 3 2 2 7
    刘蕾18 3 2 2 7
    孟思嘉20 3 2 2 7
    杜刚21 3 2 2 7
    王宏伟22 3 2 3 8
    许洁如23 3 2 3 8
    邓尧24 3 2 2 7
    邝乃乐25 3 2 2 7
    下载: 导出CSV

    表  3  纳入RCT的质量评价

    Table  3.   Quality evaluation of the included RCT

    作者 随机(分) 隐藏(分) 盲法(分) 退出(分) 合计(分)
    孙韶龙19 2 1 0 1 4
    Tangtawee12 2 2 1 1 6
    下载: 导出CSV

    表  4  发表偏倚结果

    Table  4.   Publication bias results

    结局指标 例数 Begg’s检验 Egger’s检验
    Z Pr>|Z| t P
    POPF 15 1.88 0.060 -2.58 0.023
    PPH 14 1.53 0.125 -1.97 0.072
    术后腹腔感染 11 2.80 0.005 -5.04 0.001
    术后DGE 12 0.34 0.732 -0.27 0.796
    再次手术 10 0.36 0.721 -3.10 0.015
    术后30天病死率 11 1.67 0.283 -1.65 0.137
    术后住院时间 10 0.89 0.371 -0.44 0.671
    手术时间 10 0.36 0.721 0.62 0.551
    下载: 导出CSV
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  • 收稿日期:  2023-04-12
  • 录用日期:  2023-05-24
  • 出版日期:  2024-01-23
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