本文選題：胰十二指腸切除術(shù) + 胰胃吻合��； 參考：《福建醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:評(píng)價(jià)胰十二指腸切除術(shù)后胰胃吻合與胰腸吻合的療效。方法:通過計(jì)算機(jī)檢索Pub Med、EMBASE、The Cochrane Library databases、中國生物醫(yī)學(xué)數(shù)據(jù)庫(CBM)、相關(guān)期刊論文(CNKI),收集所有比較胰十二指腸切除術(shù)后胰胃吻合術(shù)與胰腸吻合術(shù)療效的隨機(jī)對(duì)照試驗(yàn),按照既定的納入、排除標(biāo)準(zhǔn),檢出符合評(píng)價(jià)標(biāo)準(zhǔn)的文獻(xiàn),對(duì)納入文獻(xiàn)進(jìn)行質(zhì)量評(píng)估、證據(jù)水平評(píng)價(jià)、發(fā)表偏倚評(píng)價(jià),并提取所需數(shù)據(jù),采用Rev Man 5.2軟件進(jìn)行Meta分析。結(jié)果:納入7篇隨機(jī)對(duì)照試驗(yàn)(包含1121病人)。其中559例患者進(jìn)行了胰腸吻合術(shù),562例患者行胰胃吻合術(shù)。Meta分析結(jié)果顯示:1.胰十二指腸切除術(shù)后胰胃吻合可以明顯降低術(shù)后總胰瘺發(fā)生率(OR 1.70,95%CI:1.22-2.35,P=0.002)。在對(duì)高危組患者進(jìn)行亞組分析后也得出了同樣結(jié)論(OR 2.55,95%CI:1.30-5.01,P=0.006),該結(jié)果的證據(jù)級(jí)別為中級(jí)。2.胰胃吻合組患者術(shù)后腹腔內(nèi)積液發(fā)生率明顯低于胰腸吻合組(OR 2.33,95%CI:1.53-3.56,P0.0001)。3.胰胃吻合能明顯減少患者住院天數(shù)(SMD 1.00,95%CI:0.34-1.65,P=0.003),但考慮存在較高的異質(zhì)性(I2=90%),該結(jié)果的證據(jù)級(jí)別為極低級(jí),并不可靠。4.兩組在術(shù)后胃排空延遲發(fā)生方面未存在統(tǒng)計(jì)學(xué)差異(OR 1.02,95%CI:0.55-1.89,P=0.95)。但對(duì)采用同一定義的文章進(jìn)行亞組分析結(jié)果則顯示胰腸吻合在術(shù)后胃排空延遲方面存在優(yōu)勢(shì)(OR 0.60,95%CI:0.38-0.96,P=0.03),該結(jié)果的證據(jù)級(jí)別為中級(jí)。5.胰胃吻合組和胰腸吻合組在術(shù)后總并發(fā)癥發(fā)生率上無顯著性差異(OR 1.14,95%CI:0.84-1.57,P=0.40),考慮到這個(gè)結(jié)果同樣存在明顯異質(zhì)性(I2=30%),在對(duì)異質(zhì)性進(jìn)行敏感性分析后我們發(fā)現(xiàn),胰胃吻合方式的不同,術(shù)中是否使用胰腺導(dǎo)管支架,術(shù)中及術(shù)后是否使用生長抑素抑制劑是該異質(zhì)性的重要來源。6.兩組在術(shù)后出血,術(shù)后死亡率等并發(fā)癥方面無明顯差別。結(jié)論:基于這篇meta分析,胰十二指腸切除術(shù)后胰胃吻合能明顯降低術(shù)后胰瘺及腹腔內(nèi)積液的發(fā)生率,也能縮短住院時(shí)間,但存在增加術(shù)后胃排空延遲發(fā)生的風(fēng)險(xiǎn)�？紤]到存在臨床及方法學(xué)方面的異質(zhì)性,我們期待有更高質(zhì)量的隨機(jī)對(duì)照試驗(yàn)驗(yàn)證我們的分析結(jié)果。
[Abstract]:Objective: to evaluate the curative effect of pancreaticogastric anastomosis and pancreaticojejunostomy after pancreaticoduodenectomy. Methods: the Pub Medmella Cochrane Library databases, Chinese biomedical database and the full text database of Chinese periodicals were searched by computer. All the randomized controlled trials were conducted to compare the effect of pancreaticoduodenectomy and pancreaticojejunostomy. According to the established inclusion and exclusion criteria, the documents which accord with the evaluation criteria were detected. The quality evaluation, the evidence level evaluation, the publication bias evaluation of the included documents were carried out, and the necessary data were extracted, and the Meta analysis was carried out with Rev Man 5.2 software. Results: seven randomized controlled trials (including 1121 patients) were included. 559 patients underwent pancreaticojejunostomy and 562 patients underwent pancreaticogastric anastomosis. After pancreaticoduodenectomy, pancreaticogastric anastomosis could significantly reduce the incidence of postoperative total pancreatic fistula (OR 1.7095 CI: 1.22-2.35% P0. 002). After subgroup analysis of patients in high-risk group, the same conclusion was obtained, or 2.55 ~ 95% CI: 1.30-5.01% P0. 006, the evidence level of this result was intermediate. 2. The incidence of intraperitoneal effusion in the pancreaticogastric anastomosis group was significantly lower than that in the pancreaticojejunostomy group. Pancreaticogastric anastomosis could significantly reduce the days of hospitalization of patients with SMD 1.00 ~ 95% CI: 0.34-1.65Ph 0.003, but considering the existence of higher heterogeneity, the evidence level of this result was very low and unreliable. There was no significant difference in the occurrence of delayed gastric emptying between the two groups. However, the results of subgroup analysis with the same definition showed that there was an advantage in gastric emptying delay after pancreaticojejunostomy. There was no significant difference in the incidence of postoperative complications between the pancreaticogastric anastomosis group and the pancreaticojejunostomy group. The important source of this heterogeneity is whether the pancreatic stent is used during the operation and whether the somatostatin inhibitor is used during or after the operation. There was no significant difference in postoperative bleeding, postoperative mortality and other complications between the two groups. Conclusion: based on this meta analysis, pancreaticogastric anastomosis after pancreaticoduodenectomy can significantly reduce the incidence of postoperative pancreatic fistula and intraperitoneal effusion, and shorten the hospitalization time, but there is a risk of delayed gastric emptying after pancreaticoduodenectomy. In view of the clinical and methodological heterogeneity, we look forward to a higher quality randomized controlled trial to validate our results.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R657.5

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 Yun-Mee Choe;Keon-Young Lee;Cheong-Ah Oh;Joung-Bum Lee;Sun Keun Choi;Yoon-Seok Hur;Sei-Joong Kim;Young Up Cho;Seung-Ik Ahn;Kee-Chun Hong;Seok-Hwan Shin;Kyung-Rae Kim;;Risk factors affecting pancreatic fistulas after pancreaticoduodenectomy[J];World Journal of Gastroenterology;2008年45期

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本文編號(hào)：1939026