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- Title
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.
- Authors
史亚波; 李扬; 刘华兵; 智聪; 黄长文
- Abstract
To systematically evaluate the efficacy and safety of omental wrapping technique for pancreaticojejunal anastomosis in preventing complications after pancreaticoduodenectomy. Methods This study was conducted according to the PRISMA guideline. English and Chinese databases including CNKI, Wanfang Data, VIP, CBM, the Cochrane Library, PubMed, Embase, and Web of Science were searched for clinical studies on omental wrapping technique for pancreaticojejunal anastomosis in preventing complications after pancreaticoduodenectomy published up to November 2022, and Stata 16 and Review Manager 5.4 were used to perform the meta-analysis. Results A total of 15 studies with 1 830 patients were included in this study. The metaanalysis showed that the omental wrapping group had a significantly lower overall incidence rate of postoperative pancreatic fistula (POPF) than the non-omental wrapping group (odds ratio [OR]=0.30, 95% confidence interval [CI]: 0.22 — 0.41, P<0.001), and the subgroup analysis showed that the omental wrapping group had a significantly lower incidence rate of grade B/C POPF than the nonomental wrapping group (OR=0.29, 95%CI: 0.21 — 0.39, P<0.001). Compared with the non-omental wrapping group, the omental wrapping group had significantly lower incidence rates of postoperative bile leakage (OR=0.30, 95%CI: 0.16 — 0.56, P<0.001), postoperative hemorrhage (OR=0.35, 95%CI: 0.24 — 0.53, P<0.001), delayed gastric emptying (OR=0.45, 95%CI: 0.31 — 0.64, P< 0.001), abdominal infection (OR=0.55, 95%CI: 0.40 — 0.75, P<0.001), reoperation (OR=0.31, 95%CI: 0.18 — 0.54, P<0.001), and death within 30 days after surgery (OR=0.42, 95%CI: 0.22 — 0.80, P=0.009), a significantly earlier time to diet (mean difference [MD]=−0.98, 95%CI: −1.84 to −0.11, P=0.03), and a significantly shorter length of postoperative hospital stay (MD=−2.44, 95%CI: −4.10 to −0.77, P=0.004). There were no significant differences between the two groups in the time of operation (MD= −13.68, 95%CI: −28.31 to −0.95, P=0.07) and intraoperative blood loss (MD=−17.26, 95%CI: −57.55 to −23.03, P=0.40). Conclusion Omental wrapping can reduce the incidence rates of postoperative complications such as pancreatic fistula, bile leakage, postoperative hemorrhage, abdominal infection, and delayed gastric emptying, improve the prognosis of patients, and shorten the length of hospital stay, without increasing surgical difficulty or time of operation.
- Publication
Journal of Clinical Hepatology / Linchuang Gandanbing Zazhi, 2024, Vol 40, Issue 1, p129
- ISSN
1001-5256
- Publication type
Article
- DOI
10.12449/JCH240122