Duct-to-mucosa versus invagination pancreaticojejunostomy after pancreaticoduodenectomy： a meta-analysis

作     者：BAI Xue-li ZHANG Qi Noman Masood Waqas Masood GAO Shun-liang ZHANG Yun Shazmeen Shahed LIANG Ting-bo 

作者机构：Department of Hepatobiliary and Pancreatic Surgery the Second Affiliated Hospital Zhejiang University School of Medicine. Hangzhou Zhejiang 310009 China Zhejiang University School of Medicine Hangzhou Zhejiang310058 China 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2013年第126卷第22期

页      面：4340-4347页

核心收录：

学科分类：090502[农学-动物营养与饲料科学] 07[理学] 0905[农学-畜牧学] 09[农学] 070104[理学-应用数学] 0701[理学-数学] 

基　　金：国家自然科学基金国家杰出青年科学基金 the Innovation and High-Level Talent Training Program of Department of Health of Zhejiang 

主　　题：duct-to-mucosa invagination pancreaticojejunostomy, pancreaticoduodenectomy meta-analysis 

摘      要：Background Postoperative pancreatic fistula remains one of the most common and troublesome complications following pancreaticoduodenectomy. No consensus exists regarding the optimal pancreaticojejunostomy reconstruction technique to reduce this complication. We aimed to perform a systematic review comparing two commonly used techniques of pancreaticojejunostomy reconstruction （duct-to-mucosa versus invagination）, by meta-analysis and assessment of evidence quality. Methods Databases searched including The Cochrane Library, Medline, PubMed, Embase, etc. Randomized controlled trials （RCTs） comparing duct-to-mucosa and invagination pancreaticojejunostomy were included. Outcomes of interest were pancreatic fistula rate, mortality, morbidity, reoperation and hospital stay. Pooled estimates were expressed as risk ratio （RR） or mean difference. Results From 321 identified abstracts, four RCTs （467 patients; duct-to-mucosa： 232; invagination： 235） were included. Pancreatic fistula rate （RR, 0.74; 95% confidence interval （C/）： 0.24-2.28; P=0.60）, mortality （RR, 1.18; 95% CI： 0.39- 3.54; P=0.77）, morbidity （RR, 0.91; 95% CI： 0.69-1.21; P=0.53）, reoperation （RR, 1.09; 95% CI： 0.54-2.22; P=-0.81） and hospital stay （mean difference, -1.78; 95% CI： -4.60-1.04; P=0.22） were similar between techniques. Conclusions Duct-to-mucosa and invagination pancreaticojejunostomy are comparable with regards to assessed parameters. High-quality, large-volume, multi-center RCTs with standard outcome definitions are required.