背景:非甾体抗炎药(NSAID)的使用已被研究为胰十二指肠切除术(PD)后术后胰瘘(POPF)的可改变的危险因素。本研究包括系统评价和荟萃分析,探讨围手术期使用NSAID对PD后POPF发生率的影响。
方法:进行了符合PRISMA2020的系统评价。集合平均差(MD),赔率比(OR),计算风险比(RR)和95%置信区间(CI)。
结果:纳入了2015-2021年发表的七项研究,报告2,851个PD(1,372个接收NSAIDs,1,479个未收到NSAIDs)。失血没有差异(MD-99.40mL;CI-201.71-2.91;P=0.06),总发病率(OR1.05;CI0.68-1.61;P=0.83),出血(OR2.35;CI0.48-11.59;P=0.29),胃排空延迟(OR0.98;0.60-1.60;P-0.93),胆漏(OR0.68;CI0.12-3.89;P=0.66),手术部位感染(OR1.02;CI0.33-3.22;P=0.97),脓肿(OR0.99;CI0.51-1.91;P=0.97),临床相关POPF(OR1.18;CI0.84-1.64;P=0.33),再入院(OR0.94;CI0.61-1.46;P=0.78),或再次手术(OR0.82;CI0.33-2.06;P=0.68)。使用NSAID与住院时间较短相关(MD-1.05天;CI-1.39-0.71;P<0.00001)。
结论:在接受PD的患者围手术期使用NSAIDs与POPF发生率的增加无关。
BACKGROUND: Nonsteroidal anti-inflammatory drug (NSAID) use has been investigated as a modifiable risk factor for postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD). This study comprises a systematic review and meta-analysis examining the impact of perioperative NSAID use on rates of POPF after PD.
METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020-compliant systematic review was performed. Pooled mean differences (MD), odds ratios (OR), and risk ratios with 95% CIs were calculated.
RESULTS: Seven studies published from 2015 to 2021 were included, reporting 2851 PDs (1372 receiving NSAIDs and 1479 not receiving NSAIDs). There were no differences regarding blood loss (MD -99.40 mL; 95% CI, -201.71 to 2.91; P = .06), overall morbidity (OR 1.05; 95% CI, 0.68-1.61; P = .83), hemorrhage (OR 2.35; 95% CI, 0.48-11.59; P = .29), delayed gastric emptying (OR 0.98; 95% CI, 0.60-1.60; P = .93), bile leak (OR 0.68; 95% CI, 0.12-3.89; P = .66), surgical site infection (OR 1.02; 95% CI, 0.33-3.22; P = .97), abscess (OR 0.99; 95% CI, 0.51-1.91; P = .97), clinically relevant POPF (OR 1.18; 95% CI, 0.84-1.64; P = .33), readmission (OR 0.94; 95% CI, 0.61-1.46; P = .78), or reoperation (OR 0.82; 95% CI, 0.33-2.06; P = .68). NSAID use was associated with a shorter hospital stay (MD -1.05 days; 95% CI, -1.39 to 0.71; P < .00001).
CONCLUSIONS: The use of NSAIDs in the perioperative period for patients undergoing PD was not associated with increased rates of POPF.