目的:在临床相关的术后胰瘘(CR-POPFs)方面,关于胰肠吻合术后支架置入术的益处仍缺乏共识。本研究旨在分析支架置入的效果,支架技术(内部和外部),支架尺寸,CR-POPFs上主胰管扩张。
方法:我们的研究包括对接受胰肠吻合术患者的随机对照试验的系统评价和荟萃分析。主要结果定义为CR-POPFs的发生率。此外,进行了亚组分析,并进行汇总分析以提供比较参考.
结果:12项随机对照试验,包括总共1117名患者,包括在内。与未置入支架相比,支架置入与CR-POPF发生率降低没有显著关联(比值比[OR]=0.60,95%CI:0.34-1.04,P=0.07)。亚组分析显示,只有外部支架,而不是内部支架,与未放置支架相比,CR-POPF发生率降低显著相关(OR=0.53,95%CI:0.28-0.99,P=0.05vs.OR=0.92,95%CI:0.28-3.05,P=0.89)。此外,在主胰管直径≤3毫米的患者中放置支架,而不是那些主胰管直径>3毫米的人,与未放置支架相比,CR-POPF发生率显着降低(OR=0.24,95%CI:0.07-0.78,P=0.02vs.OR=1.58,95%CI:0.41-6.06,P=0.50)。
结论:研究结果表明,外支架置入在预防胰肠吻合术后CR-POPFs方面具有潜在的作用,尤其是胰管未扩张的患者。我们的研究结果的可靠性受到所包括的研究数量有限的限制。
■CRD42022380103。
OBJECTIVE: There remains a lack of consensus regarding the benefits of stent placement following pancreaticojejunostomy in terms of clinically relevant postoperative pancreatic fistulas (CR-POPFs). This study was aimed at analyzing the effects of stent placement, stent technique (internal and external), stent size, and dilation of the main pancreatic duct on CR-POPFs.
METHODS: Our study comprised a systematic
review and meta-analysis of randomized controlled trials involving patients undergoing pancreaticojejunostomy. The primary outcome was defined as the incidence of CR-POPFs. Additionally, subgroup analyses were conducted, and pooled analyses were performed to provide comparative references.
RESULTS: Twelve randomized controlled trials, including a total of 1117 patients, were included. Compared with no stent placement, stenting did not exhibit a significant association with reduced CR-POPF incidence (odds ratio [OR] = 0.60, 95% CI: 0.34-1.04, P = 0.07). Subgroup analysis revealed that only external stents, and not internal stents, were significantly associated with a reduced CR-POPF incidence compared with no stent placement (OR = 0.53, 95% CI: 0.28-0.99, P = 0.05 vs. OR = 0.92, 95% CI: 0.28-3.05, P = 0.89). Furthermore, stent placement in patients with a main pancreatic duct diameter of ≤3 mm, and not in those with a main pancreatic duct diameter of >3 mm, was associated with a significantly reduced CR-POPF incidence compared with no stent placement (OR = 0.24, 95% CI: 0.07-0.78, P = 0.02 vs. OR = 1.58, 95% CI: 0.41-6.06, P = 0.50).
CONCLUSIONS: The findings suggest a potential role for external stent placement in the prevention of CR-POPFs after pancreaticojejunostomy, particularly in patients with undilated pancreatic ducts. The reliability of our findings is constrained by the limited number of studies included.
UNASSIGNED: CRD42022380103.