术后胰瘘(POPF)是远端胰腺切除术(DP)后的严重并发症;然而,目前尚不清楚如何有效降低发病率。这项荟萃分析的目的是确定增强的钉合是否会减少DP后的POPF。2007年2月至2023年4月,在PubMed/Medline对电子数据和参考文献进行了全面搜索,Embase,WebofScience,Cochrane中央受控试验登记册,和Cochrane系统评价数据库。在这项研究中,使用ReviewManagerSoftware评估强化吻合器(RS)组和标准吻合器(SS)组的围手术期结局.使用固定或随机效果模型,计算合并比值比(ORs)和平均差(MDs)以及95%置信区间(CIs).总的来说,纳入3项随机临床试验(RCT),纳入425例患者,5项观察性临床研究(OCS),纳入318例患者.在来自随机对照试验的汇总荟萃分析中,两组POPF发生率无差异(OR=0.79;95%CI[0.47,1.35];P=0.39),术中失血量(MD=10.66;95%CI[-28.83,50.16];P=0.6),手术时间(MD=9.88;95%CI[-8.92,28.67];P=0.3),主要发病率(OR=1.12;95%CI[0.67,1.90];P=0.66),再次手术(OR=0.97;95%CI[0.41,2.32];P=0.95),再入院(OR=0.99;95%CI[0.57,1.72];P=0.97)或住院时间(MD=-0.95;95%CI[-5.22,3.31];P=0.66)。然而,OCS组的POPF和再入院结果对RS有利。
Postoperative pancreatic fistula (POPF) is a severe complication after distal pancreatectomy (DP); however, it is unclear how to effectively reduce the incidence. The purpose of this meta-analysis is to determine whether reinforced stapling reduces POPF after DP. From February 2007 to April 2023, a comprehensive search of electronic data and references was conducted in PubMed/Medline, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews. In this study, the perioperative outcomes were evaluated for the reinforced stapler (RS) group and the standard stapler (SS) group in DP using
Review Manager Software. Using fixed- or random-effects models, pooled odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated. In total, three randomized clinical trials (RCTs) with 425 patients and five observational clinical studies (OCS) with 318 patients were included. In pooled meta-analyses from RCTs, there was no difference between the two groups in the incidence of POPF (OR = 0.79; 95% CI [0.47,1.35]; P = 0.39), intraoperative blood loss (MD = 10.66; 95% CI [- 28.83,50.16]; P = 0.6), operative time (MD = 9.88; 95% CI [- 8.92,28.67]; P = 0.3), major morbidity (OR = 1.12; 95% CI [0.67,1.90]; P = 0.66), reoperation (OR = 0.97; 95% CI [0.41,2.32]; P = 0.95), readmission (OR = 0.99; 95% CI [0.57,1.72]; P = 0.97) or hospital stay (MD = - 0.95; 95% CI [- 5.22,3.31]; P = 0.66). However, the results of POPF and readmission were favorable for RS in the OCS group.